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Study sets matching "fordney chapter 11"

69 terms
FORDNEY CHAPTER 11
EPO
HMO
MCO
ERISA
EXCLUSIVE PROVIDER ORGANIZATION
HEALTH MAITENANCE ORGANIZATION
MANAGED CARE ORGANIZATION
EMPLOYEE RETIREMENT INCOME SECURITY ACT
EPO
EXCLUSIVE PROVIDER ORGANIZATION
HMO
HEALTH MAITENANCE ORGANIZATION
21 terms
Fordney chapter 11
PPO
POS
PPG
QIO
PREFERRED PROVIDER ORGANIZATION
PLACE OF SERVICE OR POINT OF SERVICE
PHYSICIAN PROVIDER GROUP
QUALITY IMPROVEMENT ORGANIZATION
PPO
PREFERRED PROVIDER ORGANIZATION
POS
PLACE OF SERVICE OR POINT OF SERVICE
15 terms
Fordney Chapter 11 Review
A copayment in a managed care plan is…
In times past physicians in private pr…
Usually there are no deductibles for m…
Ross-Loss medical group America's olde…
true
true
true
false
A copayment in a managed care plan is…
true
In times past physicians in private pr…
true
37 terms
Fordney Insurance Handbook Chapter 11
ancillary services
buffing
capitation
carve outs
Supportive services other than routine hospital services prov…
A physicians justifying the transference of sick, high-cost p…
System of payment used by managed care plans in which physici…
Medical services not included within the capitation rate as b…
ancillary services
Supportive services other than routine hospital services prov…
buffing
A physicians justifying the transference of sick, high-cost p…
17 terms
Fordney Chapter
If a patient under a managed care plan…
When a patient receives diagnosis test…
sliding scales for discounts and per d…
discounts in the form of sliding scale
Patient must be referred by primary care physicians and must…
the 3 day payment window or 42 hours rule
interim per Diem paid for each day in the hospital
a percentage reduction in charges for total bed days per year
If a patient under a managed care plan…
Patient must be referred by primary care physicians and must…
When a patient receives diagnosis test…
the 3 day payment window or 42 hours rule
18 terms
Fordney Chapter 9
According to insurance policy, what mu…
If a dis agreement occurs, when can a…
What are the time limits for receiving…
Interpret the E.O.B.?
Notify insurance company within a certain period of time.
Within 3 years after the claim was submitted.
4-12 weeks for paper(manual) claims, 7 days for electronic cl…
A document detailing services billed and describing payment d…
According to insurance policy, what mu…
Notify insurance company within a certain period of time.
If a dis agreement occurs, when can a…
Within 3 years after the claim was submitted.
15 terms
Fordney Review Chapter 7
MSP
DME
EIM
FDA
Medicare Secondary Payer
Durable Medical Equipment Number
Employer Identification Number
Food and Drug Administration
MSP
Medicare Secondary Payer
DME
Durable Medical Equipment Number
52 terms
Chapter 12 Fordney
What are the requirements for disabled…
What are the requirements to receive M…
What age is an individual eligible to…
How are benefits payed for in Medicare…
Must be disabled for no less than 12 months, & must receive d…
Individual(or their family) must already receive Social Secur…
At any age, so long as the patient meets with the criteria.
Through an annually increasing basic premium.
What are the requirements for disabled…
Must be disabled for no less than 12 months, & must receive d…
What are the requirements to receive M…
Individual(or their family) must already receive Social Secur…
34 terms
Fordney Chapter 6 Prefixes
A--
An--
Crypt--
Dys--
With out
No, not, without
Hidden
Painful, abnormal, difficult
A--
With out
An--
No, not, without
40 terms
Chapter 3 Fordney Abbreviations
AAMB
AAPC
ADSM
A/R
American Association of Medical Billers
American Academy of Professional coders
active duty service member
accounts Receivable
AAMB
American Association of Medical Billers
AAPC
American Academy of Professional coders
22 terms
Fordney Chapter 5 Abbreviations
AHA
AHIMA
ASCVD
ASHD
American Hospital Association
American Health Information Management Association
arteriosclerotic cardiovascluar disease
arteriosclerotic heart disease
AHA
American Hospital Association
AHIMA
American Health Information Management Association
32 terms
Fordney chapter 2 abbreviations
CCI
CD
CDT
CLIA
Correct coding initiative
compact disk
Code on dental procedures and nomenclature
clinical laboratory improvement amendments
CCI
Correct coding initiative
CD
compact disk
10 terms
Fordney Chapter 2: HIPAA
Disclosing PHI as authorized by the la…
Confidentiality between the physician…
Baby Baker was born on Feb. 4, 2005 at…
To give release or transfer informatio…
True
True
True
False
Disclosing PHI as authorized by the la…
True
Confidentiality between the physician…
True
27 terms
Fordney Chapter 12: Medicare
Medicare provides insurance for disabl…
All persons age 65 who meet eligibilit…
Medicare provides insurance for disabl…
Patients who elect Medicare Part B cov…
TRUE
FALSE
TRUE
TRUE
Medicare provides insurance for disabl…
TRUE
All persons age 65 who meet eligibilit…
FALSE
10 terms
Fordney Chapter 12 and 13
The medically needy aged is:
When a Medicare patient signs an advan…
Part A of Medicare covers:
The HCPCS national alphanumeric codes…
Require help in meeting costs of medical care
-GA
Hospital care
Level II codes
The medically needy aged is:
Require help in meeting costs of medical care
When a Medicare patient signs an advan…
-GA
23 terms
Fordney Chapter 14 Abbreviations
ADSM
CHAMPVA
DEERS
FTM
Active Duty Service Member
Civilian Health and Medical Program of the Department of Vete…
Defense Enrollment Eligibility Reporting System
Full-Time Manager
ADSM
Active Duty Service Member
CHAMPVA
Civilian Health and Medical Program of the Department of Vete…
34 terms
Fordney Chapter 6 Prefixes
A--
An--
Crypt--
Dys--
With out
No, not, without
Hidden
Painful, abnormal, difficult
A--
With out
An--
No, not, without
23 terms
Fordney Chapter 14 Abbreviations
ADSM
CHAMPVA
DEERS
FTM
Active Duty Service Member
Civilian Health and Medical Program of the Department of Vete…
Defense Enrollment Eligibility Reporting System
Full-Time Manager
ADSM
Active Duty Service Member
CHAMPVA
Civilian Health and Medical Program of the Department of Vete…
23 terms
Fordney Chapter 14 Abbreviations
ADSM
CHAMPVA
DEERS
FTM
Active Duty Service Member
Civilian Health and Medical Program of the Department of Vete…
Defense Enrollment Eligibility Reporting System
Full-Time Manager
ADSM
Active Duty Service Member
CHAMPVA
Civilian Health and Medical Program of the Department of Vete…
24 terms
Fordney Insurance Handbook Chapter 1
AHIMA
AMA
cash flow
Facility billing
American Health Information Management Association
American Medical Association
the amount of actual cash generated and available for use by…
charging for services done in hospitals, acute care hospitals…
AHIMA
American Health Information Management Association
AMA
American Medical Association
22 terms
Fordney Chapter 14 Abbreviations
CHAMPVA
DEERS
FTM
HAC
Civilian Health and Medical Program of the Department of Vete…
Defense Enrollment Eligibility Reporting System
Full-Time Manager
health administration center
CHAMPVA
Civilian Health and Medical Program of the Department of Vete…
DEERS
Defense Enrollment Eligibility Reporting System
13 terms
Fordney Chapter 9 Questions
Claim policy provisions
Explanation of benefits
Components of an EOB
Claim management techniques
Payment time limits vary by payer... paper claims: 4-12 weeks... el…
States the status of a claim... States the allowed and disallowe…
Insurance company's name and address... Provider of services... Dat…
Insurance claims register... Tickler File... Aging reports
Claim policy provisions
Payment time limits vary by payer... paper claims: 4-12 weeks... el…
Explanation of benefits
States the status of a claim... States the allowed and disallowe…
22 terms
Fordney Chapter 8 study set
When do most physicians prefer to coll…
Is credit information considered prote…
Should MAAs be familiar with manual an…
How is the amount payed for medical fe…
at check-in.
yes, credit info. is included as protected health info.
yes, MAAs should be familiar with both electronic & manual wa…
amount that the insurance company pays is based off a doctors…
When do most physicians prefer to coll…
at check-in.
Is credit information considered prote…
yes, credit info. is included as protected health info.
10 terms
Fordney Chapter 4: Medical Documentation
Preservation of health records is gove…
A review of patient records done befor…
Which of the following cases should no…
How should an entry in a patient's med…
State and local law
Prospective
Transmission of documents relating to information on sexually…
Cross out the incorrect entry, substitute the correct info, d…
Preservation of health records is gove…
State and local law
A review of patient records done befor…
Prospective
55 terms
Fordney Insurance Handbook, Chapter 9
ALJ
CMS
DAB
EOB
administrative law judge
center for medicare & medicaid
departmental appeal board
explanation of benefits
ALJ
administrative law judge
CMS
center for medicare & medicaid
70 terms
FORDNEY CHAPTER 8 THE ELECTRONIC CLAIM
ANSI
EFT
EHR
ATM
AMERICAN NATIONAL STANDARDS INSTITUTUE
ELECTRONIC FUNDS TRANSFER
ELECTRONIC HEALTH RECORD
AUTOMATIC TELLER MACHINE
ANSI
AMERICAN NATIONAL STANDARDS INSTITUTUE
EFT
ELECTRONIC FUNDS TRANSFER
20 terms
Fordney Insurance Handbook Chapter 4
What information do insurance carriers…
consulting physician
ordering physician
referring physician
documentation in the EHR substaniating procedure and diagnost…
a provider whose opinion or advice regarding evaluation or ma…
the individual int he hospital directing the selection, prepa…
a provider who sends the patient for tests or treatment
What information do insurance carriers…
documentation in the EHR substaniating procedure and diagnost…
consulting physician
a provider whose opinion or advice regarding evaluation or ma…
24 terms
Fordney Insurance Handbook Chapter 1
AHIMA
AMA
cash flow
Facility billing
American Health Information Management Association
American Medical Association
the amount of actual cash generated and available for use by…
charging for services done in hospitals, acute care hospitals…
AHIMA
American Health Information Management Association
AMA
American Medical Association
45 terms
Fordney Insurance Handbook Chapter 12
Advance Beneficiary Notice
Approved charge
Assignment
Benefit period
ABN, An agreement given to the patient to read and sign befor…
A fee that Medicare decides the medical service is worth, whi…
A transfer, after an event insured against, or an individual'…
A period of time for which payments for Medicare inpatient ho…
Advance Beneficiary Notice
ABN, An agreement given to the patient to read and sign befor…
Approved charge
A fee that Medicare decides the medical service is worth, whi…
28 terms
Fordney Insurance Handbook Chapter 15
Accident
Adjudication
By report
Claims examiner
an unexpected happening, causing injury traceable to a defini…
Final determinations of the issues involving settlement of in…
A report must be submitted with the claim when the notation "…
In industrial cases, a representative of the insurer who auth…
Accident
an unexpected happening, causing injury traceable to a defini…
Adjudication
Final determinations of the issues involving settlement of in…
90 terms
Fordney Insurance Handbook Chapter 10
accounts receivable
age analysis
American Medical Association (AMA) cod…
automatic stay
The total amount of money owed for professional services rend…
the procedure of systematically arranging the accounts receiv…
a code of medical ethics formulated by the American Medical A…
a court order that goes into effect once a bankruptcy petitio…
accounts receivable
The total amount of money owed for professional services rend…
age analysis
the procedure of systematically arranging the accounts receiv…
61 terms
Fordney Insurance Handbook, Chapter 7
clean claim
Clean claim means the following:
deleted claim
Some reasons a claim may be deleted:
A claim (paper or electronic) was submitted within the progra…
1. The claim has no deficiencies and passes all electronic ed…
A claim canceled, deleted, or voided by a Medicare Fiscal int…
CMS-1500 (08-05) or current CMS-1450 is not used, itemized ch…
clean claim
A claim (paper or electronic) was submitted within the progra…
Clean claim means the following:
1. The claim has no deficiencies and passes all electronic ed…
67 terms
FORDNEY CHAPTER 17 HOSPITAL BILLING
AEP (APPROPRIATENESS EVALUATION PROTOC…
COST OUTLINER
(QIO) QUALITY IMPROVEMENT ORGANIZATIONS
CMS 1500
CRITERIA USED FOR ADMISSION CERTIFICATION TO SEE IF PATIENT'S…
TYPICAL CASE THAT HAVE AN EXTRAORDINARY HIGH COST WHEN COMPAR…
WORK WITH CMS TO REVIEW MEDICAL NECESSITY, REASONABLENESS, AP…
CLAIM FORM FOR OUTPATIENT, PHYSICIAN SERVICES AND SUPPLIES.
AEP (APPROPRIATENESS EVALUATION PROTOC…
CRITERIA USED FOR ADMISSION CERTIFICATION TO SEE IF PATIENT'S…
COST OUTLINER
TYPICAL CASE THAT HAVE AN EXTRAORDINARY HIGH COST WHEN COMPAR…
8 terms
Fordney Chapter 8 Random Questions
Electronic data interchange
Encryption
2 weeks or less
Accounts receivable
Exchange of data in a standardized format through computer sy…
The act of converting computerized data into a code so that u…
Payment to the provider of service of an electronically submi…
The most important function of a practice management system
Electronic data interchange
Exchange of data in a standardized format through computer sy…
Encryption
The act of converting computerized data into a code so that u…
43 terms
FORDNEY CHAPTER 7 THE PAPER CLAIM
WHAT LEGISLATION REQUIRED ALL CLAIMS S…
STATE THE NAME OF THE HEALTH INSURANCE…
DOES MEDICARE ACCEPT THE CMS-1500 (02-…
WHAT IS A PENDED CLAIM?
ADMINISTRATIVE SIMPLIFICATION COMPLIANCE ACT.
CMS-1500
YES, EFFECTIVE 2014
A CLAIM THAT IS HELD FOR REVIEW OR NEED CLARIFICATION.
WHAT LEGISLATION REQUIRED ALL CLAIMS S…
ADMINISTRATIVE SIMPLIFICATION COMPLIANCE ACT.
STATE THE NAME OF THE HEALTH INSURANCE…
CMS-1500
15 terms
Fordney Insurance Handbook Chapter 13
Categorically needy
Coinsurance
Copayment
Covered services
Aged, blind, or disabled individuals or families and children…
A cost-sharing requirement under a health insurance policy pr…
A patient's payment of a portion of the cost at the time the…
Specific services and supplies for which Medicaid will provid…
Categorically needy
Aged, blind, or disabled individuals or families and children…
Coinsurance
A cost-sharing requirement under a health insurance policy pr…
42 terms
Fordney Insurance Handbook Chapter 2
abuse
American Recovery and Reinvestment Act
authorization
authorization form
misuse
This is an economic stimulus bill that provided $787 billion…
insurance claims require a patient to sign to release informa…
A document signed by the patient that is needed for use and d…
abuse
misuse
American Recovery and Reinvestment Act
This is an economic stimulus bill that provided $787 billion…
36 terms
Fordney Insurance Handbook Chapter 14
Active Duty Service Member
Allowable charge
Authorized provider
Beneficiary
An active member of the United States government military ser…
An amount on which TRICARE figures the patient's cost-share f…
A physician or other individual authorized provider of care o…
An individual entitled to receive insurance policy or governm…
Active Duty Service Member
An active member of the United States government military ser…
Allowable charge
An amount on which TRICARE figures the patient's cost-share f…
35 terms
Fordney Insurance Handbook Chapter 15
2 kinds of statutes under worker's comp
Accident
Occupational illness (Industrial or wo…
Name the federal worker's compensation…
Federal compensation laws and State compensation laws
An unexpected, unintended event that occurs at a particular t…
From working in a plastics manufacturing company and inhaling…
Workmens compensation law of the District of Columbia, Federa…
2 kinds of statutes under worker's comp
Federal compensation laws and State compensation laws
Accident
An unexpected, unintended event that occurs at a particular t…
24 terms
Fordney Insurance Handbook Chapter 16
Disability income policies do not prov…
Disability income insurance provides b…
For patients receiving VA medical care…
In 1956, Congress established a progra…
True
False
True
Social Security Disability Insurance (SSDI)
Disability income policies do not prov…
True
Disability income insurance provides b…
False
25 terms
Fordney Chapter 5 and 6 Study Guide
Four digit subcategories .8 and .9 are…
When the physician makes hospital visi…
Private health insurance plans using t…
The proficient code begins the coding…
True
True
True
False
Four digit subcategories .8 and .9 are…
True
When the physician makes hospital visi…
True
30 terms
Chapter 15 Fordney Workers' Compensation
Name two kinds of statutes under worke…
An unexpected, unintended event that o…
Maria Cardoza works in a plastics manu…
Name the federal workers' compensation…
Federal ... Sate
Accident
Occupational illness
1. Workmen's Compensation Law of the District of Columbia. 2.…
Name two kinds of statutes under worke…
Federal ... Sate
An unexpected, unintended event that o…
Accident
68 terms
Fordney Insurance Handbook - Chapter 8
1) *Fill-in Question* Define encrypt…
2) Why are electronic transmissions en…
3) Define batch
4) When can payments be received after…
is used for security purposes to assign a code to represent d…
so that they cannot be opned and read if intercepted (receive…
is a group of claims for different patients sent at the same…
in 2 weeks or less
1) *Fill-in Question* Define encrypt…
is used for security purposes to assign a code to represent d…
2) Why are electronic transmissions en…
so that they cannot be opned and read if intercepted (receive…
19 terms
chapter 17 fordney Insurance Handbook
What is a grouper?
What is DRG?
72 hour rule?
What is a QIO responsible for?
A computer software program that calculates and assigns the D…
diagnosis-related groups
or the 3 day payment window, is when a patient receives diagn…
Quality Improvement Organization is an organization that revi…
What is a grouper?
A computer software program that calculates and assigns the D…
What is DRG?
diagnosis-related groups
26 terms
Fordney Insurance Handbook Chapter 9 & 10 Review
Accounts receivable are usually aged i…
Under federal regulations, a list of t…
A patient has a $600 balance and agree…
All collection calls should be placed:
30, 60, 90, and 120 days.
True
True
After 8 AM and before 9 PM.
Accounts receivable are usually aged i…
30, 60, 90, and 120 days.
Under federal regulations, a list of t…
True
32 terms
Fordney Insurance Handbook Chapter 2 abbreviations
ARRA
CD
CERT
CLIA
American Recovery and Reinvestment Act
compact disk
comprehensive error rate testing
clinical laboratory improvement amendments
ARRA
American Recovery and Reinvestment Act
CD
compact disk
19 terms
Kinns Chapter 22 and Fordney Chapter 8
Additional costs that should be discus…
Equal Credit Opportunity Act
Cycle Billing
Lost Claim
Cost of anesthesiology... Cost of Operation... Radiologist fees... and…
The act that extends credit for services to all patients equa…
Certain portions of account receivable billed at given times…
After claim is submitted, not dated, or stamped after 24 hour…
Additional costs that should be discus…
Cost of anesthesiology... Cost of Operation... Radiologist fees... and…
Equal Credit Opportunity Act
The act that extends credit for services to all patients equa…
24 terms
Fordney Chapter 5 and 6 Study Guide
Four digit subcategories .8 and .9 are…
When the physician makes hospital visi…
Private health insurance plans using t…
The proficient code begins the coding…
True
True
True
False
Four digit subcategories .8 and .9 are…
True
When the physician makes hospital visi…
True
30 terms
Fordney Chapter 10: Office and Insurance Collection Strategies
It is often the practice administrator…
A large percentage of reimbursement in…
Information provided on the patient re…
If a patient refuses to divulge any ne…
TRUE
TRUE
TRUE
FALSE
It is often the practice administrator…
TRUE
A large percentage of reimbursement in…
TRUE
25 terms
Fordney Chapter 13: Medicaid and Other State Programs
The federal government financially sup…
TEFRA stands for Tax Equity and Financ…
The federal government designs the Med…
Medicaid is not so much an insurance p…
TRUE
FALSE
FALSE
TRUE
The federal government financially sup…
TRUE
TEFRA stands for Tax Equity and Financ…
FALSE
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