How can we help?

You can also find more resources in our Help Center.

Study sets matching "billing medical coding chapter 5"

Study sets
Classes
Users

Study sets matching "billing medical coding chapter 5"

Medical Billing and Coding Chapter 5
physician's fee profile
primary diagnosis
secondary diagnosis
etiology
Each physician's charges and the payments made to him or her…
The first listed condition (chief complaint) of a claim for a…
Listed after the primary diagnosis, may contribute to the con…
The underlying cause of a disease.
physician's fee profile
Each physician's charges and the payments made to him or her…
primary diagnosis
The first listed condition (chief complaint) of a claim for a…
54 terms
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
54 terms
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
199 terms
MEDICAL BILLING/CODING ACRONYMS
Acct.
A/P
A/R
AMA
Account
ACCOUNT Payable
Account Receivable
American Medical Association
Acct.
Account
A/P
ACCOUNT Payable
126 terms
Medical Billing and Coding Final
What is a rule of conduct established…
Another name for terminating care of a…
A health-care professional who stops c…
The appropriate way for a physician to…
Law
D) withdrawing from a case
D) abandonment
Send the patient a certified letter
What is a rule of conduct established…
Law
Another name for terminating care of a…
D) withdrawing from a case
30 terms
Medical Billing & Coding Module 5
Orthotics
Prosthetics
HCPCS Level II Temporary Codes
Ambulatory Surgical Center (ASC)
is a branch of medicine that deals with the design and fittin…
is a branch of medicine that deals with the design, productio…
are maintained by the CMS and other members of the HCPCS Nati…
is a state-licensed, Medicare-certified supplier (not provide…
Orthotics
is a branch of medicine that deals with the design and fittin…
Prosthetics
is a branch of medicine that deals with the design, productio…
54 terms
Medical Billing & Coding: Heald College: Chapter 5 | Diagnostic Coding
Why must diagnostic coding be accurate?
What is the Primary Diagnosis?
What is the Secondary Diagnosis?
What is the Principal Diagnosis?
1. Payment for inpatient services rendered to a patient may b…
1. Related to the chief complaint... 2. Main reason for the enco…
1. May contribute to the primary diagnosis... 2. Not the underly…
1. Only applicable to inpatient cases/claims... 2. Similar to pr…
Why must diagnostic coding be accurate?
1. Payment for inpatient services rendered to a patient may b…
What is the Primary Diagnosis?
1. Related to the chief complaint... 2. Main reason for the enco…
30 terms
medical billing and coding
modifier 22
23
24
25
increased procedural service
unusual anesthesia
unrelated E&M service during post operation period
significant separately identifiable E&M on same day of the pr…
modifier 22
increased procedural service
23
unusual anesthesia
126 terms
Medical Billing and Coding Final
What is a rule of conduct established…
Another name for terminating care of a…
A health-care professional who stops c…
The appropriate way for a physician to…
Law
D) withdrawing from a case
D) abandonment
Send the patient a certified letter
What is a rule of conduct established…
Law
Another name for terminating care of a…
D) withdrawing from a case
30 terms
Medical Billing & Coding Module 5
Orthotics
Prosthetics
HCPCS Level II Temporary Codes
Ambulatory Surgical Center (ASC)
is a branch of medicine that deals with the design and fittin…
is a branch of medicine that deals with the design, productio…
are maintained by the CMS and other members of the HCPCS Nati…
is a state-licensed, Medicare-certified supplier (not provide…
Orthotics
is a branch of medicine that deals with the design and fittin…
Prosthetics
is a branch of medicine that deals with the design, productio…
199 terms
MEDICAL BILLING/CODING ACRONYMS
Acct.
A/P
A/R
AMA
Account
ACCOUNT Payable
Account Receivable
American Medical Association
Acct.
Account
A/P
ACCOUNT Payable
26 terms
Billing and Coding chapter 5
category 1 codes
category 2 codes
category 3 codes
section guidelines
procedure codes found in the main body of CPT
optional CPT codes that track performance measures
temporary codes for emerging technology, services, and proced…
usage notes at the beginning of CPT sections
category 1 codes
procedure codes found in the main body of CPT
category 2 codes
optional CPT codes that track performance measures
26 terms
Billing and Coding chapter 5
category 1 codes
category 2 codes
category 3 codes
section guidelines
procedure codes found in the main body of CPT
optional CPT codes that track performance measures
temporary codes for emerging technology, services, and proced…
usage notes at the beginning of CPT sections
category 1 codes
procedure codes found in the main body of CPT
category 2 codes
optional CPT codes that track performance measures
45 terms
Introduction to Medical Billing & Coding
WHO
ICD
Who developed ICD to:
CPT
World Health Organization
International Classification of Diseases
collect data for statistical purposes
Current Procedural Terminiology
WHO
World Health Organization
ICD
International Classification of Diseases
56 terms
Medical Billing, Coding, and Insurance-Chapter 1
Cash Flow
Accounts Receivable (AR)
Accounts Payable (AP)
Revenue Cycle Management (RCM)
movement of monies into or out of a business.
monies owed to a medical practice.
a practice's operating expenses.
process of making sure sufficient monies flow into the practi…
Cash Flow
movement of monies into or out of a business.
Accounts Receivable (AR)
monies owed to a medical practice.
5 terms
medical insurance billing and coding
english
billing codes
cpt codes
medical insurance
...
icd 10
cpt 9
health insurance today
english
...
billing codes
icd 10
29 terms
Chapter 5 (Billing and Coding)
Professional component
Increased procedural service
Two surgeons
Multiple procedures
26; used to report professional components when a procedure h…
22; used with rare unusual or variable surgery services, requ…
62; used when a specific surgical procedure requires two surg…
51; used to identify a second procedure or multiple procedure…
Professional component
26; used to report professional components when a procedure h…
Increased procedural service
22; used with rare unusual or variable surgery services, requ…
31 terms
Medical Coding and Billing - CPT Coding
CPT
Overview of CPT
CPT Supports electronic data
EDI
CPT stands for current procedural terminology. It provides er…
CPT provides a list of identifying and descriptive codes for…
Exchange (EDI), computer based patient.... Record (CPR), electro…
Electronic Data Interchange.
CPT
CPT stands for current procedural terminology. It provides er…
Overview of CPT
CPT provides a list of identifying and descriptive codes for…
45 terms
Introduction to Medical Billing & Coding
WHO
ICD
Who developed ICD to:
CPT
World Health Organization
International Classification of Diseases
collect data for statistical purposes
Current Procedural Terminiology
WHO
World Health Organization
ICD
International Classification of Diseases
30 terms
Medical Billing & Coding Module 2
Primary Insurance
Secondary Insurance
Encounter Form
Claims Submission
is the insurance plan responsible for paying health care insu…
is the insurance plan that is billed after the primary insura…
is the financial record source document used by health care p…
is the electronic or manual transmission of claims data to pa…
Primary Insurance
is the insurance plan responsible for paying health care insu…
Secondary Insurance
is the insurance plan that is billed after the primary insura…
30 terms
Medical Billing & Coding Module 1
Health Insurance Claim
Medical Assistant
Remittance Advice
Professional Liability Insurance
is the documentation submitted to a third-party payer or gove…
is employed by a provider to perform administrative and clini…
which is a notice sent by the insurance company that contains…
which provides protection from claims that contain errors and…
Health Insurance Claim
is the documentation submitted to a third-party payer or gove…
Medical Assistant
is employed by a provider to perform administrative and clini…
30 terms
Medical Billing & Coding Module 8
Medicare Part A
Medicare Part B
Medicare Hospital Insurance (Medicare…
Medicare Advantage (Medicare Part C)
reimburses institutional providers for inpatient, hospice, an…
reimburses institutional providers for outpatient services an…
pays for inpatient hospital critical care access; skilled nur…
formerly called Medicare+Choice, includes managed care and pr…
Medicare Part A
reimburses institutional providers for inpatient, hospice, an…
Medicare Part B
reimburses institutional providers for outpatient services an…
13 terms
Medical Billing (Chapter 5/Key Terms)
(APCs) ambulatory *payment classific…
(CMI) case mix index
(DRGs) diagnosis-related groups
DRG weight
A medicare payment classification for outpatient services
A measure of the clinical severity or resource requirements
A system of analyzing conditions and treatments for similar *…
Under the Medicare Inpatient Prospective Payment System, a na…
(APCs) ambulatory *payment classific…
A medicare payment classification for outpatient services
(CMI) case mix index
A measure of the clinical severity or resource requirements
30 terms
Medical Billing & Coding Module 2
Primary Insurance
Secondary Insurance
Encounter Form
Claims Submission
is the insurance plan responsible for paying health care insu…
is the insurance plan that is billed after the primary insura…
is the financial record source document used by health care p…
is the electronic or manual transmission of claims data to pa…
Primary Insurance
is the insurance plan responsible for paying health care insu…
Secondary Insurance
is the insurance plan that is billed after the primary insura…
42 terms
Chapter 4-5 Medical Coding and Billing
Accept assignment
Accounts receivable
Assignment of benefits
Birthday rule
provider accepts as payment in full whatever is paid on the c…
the amount owed to a business for services or goods provided.
the provider receives reimbursement directly from the payer.
determines coverage by primary and secondary policies when ea…
Accept assignment
provider accepts as payment in full whatever is paid on the c…
Accounts receivable
the amount owed to a business for services or goods provided.
30 terms
Medical Billing & Coding Module 8
Medicare Part A
Medicare Part B
Medicare Hospital Insurance (Medicare…
Medicare Advantage (Medicare Part C)
reimburses institutional providers for inpatient, hospice, an…
reimburses institutional providers for outpatient services an…
pays for inpatient hospital critical care access; skilled nur…
formerly called Medicare+Choice, includes managed care and pr…
Medicare Part A
reimburses institutional providers for inpatient, hospice, an…
Medicare Part B
reimburses institutional providers for outpatient services an…
16 terms
Medical billing and coding chapter 1
CPT
Patient record
Physician query process
Assumption coding
Coding system used by physicians and outpatient healthcare se…
Business record for inpatient or outpatient encounter that do…
Contacting the responsible physician to request clarification…
Inappropriate assignment of codes based on assuming from a re…
CPT
Coding system used by physicians and outpatient healthcare se…
Patient record
Business record for inpatient or outpatient encounter that do…
25 terms
Medical Billing & Coding Module 7
Commercial Health Insurance
Indemnity Insurance
Automobile Insurance Policy
Disability Insurance
covers the medical expenses of individuals (e.g., private hea…
compensates policyholders for actual economic losses, up to l…
is a contract between an individual and an insurance company…
is defined as reimbursement for income lost as a result of a…
Commercial Health Insurance
covers the medical expenses of individuals (e.g., private hea…
Indemnity Insurance
compensates policyholders for actual economic losses, up to l…
30 terms
Medical Billing & Coding Module 4
Moderation Sedation
Guidelines
Descriptive Qualifiers
Modifiers
is the administration of moderate sedation or analgesia, whic…
define terms and explain the assignment of codes for procedur…
are terms that clarify the assignment of a CPT code.
clarify services and procedures performed by providers.
Moderation Sedation
is the administration of moderate sedation or analgesia, whic…
Guidelines
define terms and explain the assignment of codes for procedur…
32 terms
Chapter 5 medical billing
Medicare
CMS
End-stage renal disease
Medicare part A
Federal health insurance benefit for the aged and disabled.
Centers for Medicare and medical services organization that o…
Occurs when a patients kidneys fail to function.
Considered the basic plan or hospital insurance. Covers facil…
Medicare
Federal health insurance benefit for the aged and disabled.
CMS
Centers for Medicare and medical services organization that o…
10 terms
Medical Billing and Coding Chapter 1
Managed Care
3 Categories of a Physician's Practice
Patient Account Services (PAS)
Centralized Billing Office (CBO)
Used to describe a system in which healthcare delivery is mon…
1. Solo/Private Practice... 2. Small Group (3-9 physicians)... 3. L…
A facility that centralizes the process of billing patients a…
Specializes in (physicians' practices rather than hospitals)…
Managed Care
Used to describe a system in which healthcare delivery is mon…
3 Categories of a Physician's Practice
1. Solo/Private Practice... 2. Small Group (3-9 physicians)... 3. L…
Comprehensive Medical Coding chapter 5
Adenoma
Adenocarcinoma
Diag-
Prog-
Tumor of a gland
Cancerous tumor of a gland
Complete
Future
Adenoma
Tumor of a gland
Adenocarcinoma
Cancerous tumor of a gland
56 terms
Medical Billing, Coding, and Insurance-Chapter 1
Cash Flow
Accounts Receivable (AR)
Accounts Payable (AP)
Revenue Cycle Management (RCM)
movement of monies into or out of a business.
monies owed to a medical practice.
a practice's operating expenses.
process of making sure sufficient monies flow into the practi…
Cash Flow
movement of monies into or out of a business.
Accounts Receivable (AR)
monies owed to a medical practice.
37 terms
Medical coding and billing
Cardiomyopathy
Histology
Bilateral
Tachycardia
disease of the heart muscle
Study of tissues
Present on two sides
Fast heart rate
Cardiomyopathy
disease of the heart muscle
Histology
Study of tissues
Medical Coding and Billing Chapter 1
cash flow
accounts receivable
AR
Accounts Payable
movement of monies into or out of a business
monies owed to a medical practice
Accounts Receivable
a practice's operating expenses
cash flow
movement of monies into or out of a business
accounts receivable
monies owed to a medical practice
45 terms
understanding hospital billing and coding chapter 5
Accept assignment
Accounts receivable(AR) management
Ambulatory Payment Classifications(APC)
Ambulatory surgery
an agreement between the hospital and payer that states the h…
Refers to functions required to monitor and follow-up on outs…
The Outpatient Prospective Payment System(OPPS) reimbursement…
Surgery that is performed on the same day the patient is disc…
Accept assignment
an agreement between the hospital and payer that states the h…
Accounts receivable(AR) management
Refers to functions required to monitor and follow-up on outs…
86 terms
Medical Coding & Billing
Skin
Epidermis
Stratum germinativum
Stratum spinosum
Primary Function/Description... Protection, regulation, sensatio…
Outer protective covering of the body that can be divided int…
Innermost epidermal layer responsible for regeneration of the…
Means "spiny layer." Each time a stem cell divides one of the…
Skin
Primary Function/Description... Protection, regulation, sensatio…
Epidermis
Outer protective covering of the body that can be divided int…
347 terms
Medical Billing/Coding Terms - combined lists
(Medi-Medi)
(nonpar)
Abuse
Abuse
Refers to an individual who receives medical or disability be…
A provider who decides not to accept the determined allowable…
were doctors charge PRIVATE insurance subscribers extra for o…
incidents or practices, not usually considered fraudulent, bu…
(Medi-Medi)
Refers to an individual who receives medical or disability be…
(nonpar)
A provider who decides not to accept the determined allowable…
73 terms
chapter 8 medical billing & coding
administrative services only (ASO)
BlueCard
BlueCross BlueShield Association (BCBS)
carve out
contract where a third-party administrator or insurer provide…
program that provides benefits for subscribers who are away f…
national organization of independent companies founded in the…
part of a standard health plan changed under an employer-spon…
administrative services only (ASO)
contract where a third-party administrator or insurer provide…
BlueCard
program that provides benefits for subscribers who are away f…
65 terms
Medical Billing and Coding Chapter 4
Alphabetic Index
Approach
Benign
Body System
The coder should always begin the search for the correct code…
The method in which the coder uses to figure out a code.
Harmless
A group of organs that work together to perform a specific fu…
Alphabetic Index
The coder should always begin the search for the correct code…
Approach
The method in which the coder uses to figure out a code.
32 terms
endocrine system medical billing and coding
acr/o
adren/o, adrenal/o
cortic/o
crin/o
extremities
adrenal glands
outer region
secrete
acr/o
extremities
adren/o, adrenal/o
adrenal glands
90 terms
NHA CODING TERMS FOR MEDICAL BILLING & CODING
HIPAA
HIPAA Title I
HIPAA Title II
FCA
Health Insurance Portability & Accountability Act of 1996
Insurance Reform - to provide continuous insurance coverage f…
Administrative Simplification - to reduce costs by standardiz…
False Claims Act - federal law that prohibits submitting a fr…
HIPAA
Health Insurance Portability & Accountability Act of 1996
HIPAA Title I
Insurance Reform - to provide continuous insurance coverage f…
19 terms
Medical billing and coding Chapter 3
Accident
Actively-at-work
Aggregate Deductible
Allowed Amount
An unintentional injury that has a specific time,date and place
A provision that states that a person must be at work on the…
A deductible that requires all major medical deductibles appl…
What the insurance company considers to be a reasonable charg…
Accident
An unintentional injury that has a specific time,date and place
Actively-at-work
A provision that states that a person must be at work on the…
45 terms
Medical Coding and Billing ICD-10
The Coding Notation that adds further…
Synonyms, alternate words, and explana…
Septicemia due to unknown causes
Encephalitis due to Measles
Includes
[ ] Brackets
A41.9
B05.0
The Coding Notation that adds further…
Includes
Synonyms, alternate words, and explana…
[ ] Brackets
62 terms
Chapter 12 medical billing & coding
Admission of Liability
automobile insurance policy
disability compensation programs
Federal Employees' Compensation Act (F…
determination that an employer is responsible for an employee…
contract between an insurance company and an individual for w…
provide partial reimbursement for lost income when a disabili…
provides workers' compensation insurance for civilian employe…
Admission of Liability
determination that an employer is responsible for an employee…
automobile insurance policy
contract between an insurance company and an individual for w…
126 terms
Medical Billing and Coding Laws
What is a rule of conduct established…
Another name for terminating care of a…
A health-care professional who stops c…
The appropriate way for a physician to…
Law
D) withdrawing from a case
D) abandonment
Send the patient a certified letter
What is a rule of conduct established…
Law
Another name for terminating care of a…
D) withdrawing from a case
11 terms
Medical Billing and Coding Chapter 11 2015
ICD-9-CM assumes a relationship betwee…
If a patient is admitted for an HIV-re…
A fifth digit of 1 should be be assign…
Another term to describe malignant hyp…
True
False
False
True
ICD-9-CM assumes a relationship betwee…
True
If a patient is admitted for an HIV-re…
False
24 terms
Medical Billing and Coding Chapter 1
APG
CMS
Comorbidity
Compliance Plan
Ambulatory patient group: A payment system similar to DRG but…
Centers for Medicare and Medicaid Services
An ongoing condition that exists with another condition for w…
A structured format stating office policies and procedures fo…
APG
Ambulatory patient group: A payment system similar to DRG but…
CMS
Centers for Medicare and Medicaid Services
38 terms
Medical Billing & Coding Chapter 11
When a patient is seen by his surgeon…
According to optical scanning guidelin…
Birth dates are entered as_________ fo…
The diagnosis code reported in item A,…
billed as separate
hiphen
eight digits or 2 dig day 2 dig month 4 dig year
primary or first listed diagnosis
When a patient is seen by his surgeon…
billed as separate
According to optical scanning guidelin…
hiphen
1 of 10