Study sets matching "insurance billing coding"

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Study sets matching "insurance billing coding"

medical insurance billing and coding
english
billing codes
cpt codes
medical insurance
...
icd 10
cpt 9
health insurance today
english
...
billing codes
icd 10
Insurance Billing and Coding
Define Provider...
What is an EOB ?
What is an RA?
What is a Co-Pay?
A physician or other qualified healthcare worker
Explanation of Benefits; sent to the patient and explains how…
Remittance Advice; sent to the provider and explains how clai…
A flat amount paid by the patient at the time of service
Define Provider...
A physician or other qualified healthcare worker
What is an EOB ?
Explanation of Benefits; sent to the patient and explains how…
21 terms
Insurance and Coding- Chapter 1 - Insurance and Billing Procedures
In addition to medical data, the medic…
medical ethics will typically address…
how do you correct an error in a patie…
insurance policy
personal data, financial data, social data
conduct
draw a single line through it
a legally enforceable document composed by an insurance compa…
In addition to medical data, the medic…
personal data, financial data, social data
medical ethics will typically address…
conduct
26 terms
Billing, Insurance, Coding
ABA routing number
Accounting
Accounts payable
Accounts receivable
A nine-digit number that identifies a bank; the number is pri…
Systemic recording and reporting of financial transactions.
The outstanding bills of business, such as a Medical Office.
Total amount owed to a business for goods and services.
ABA routing number
A nine-digit number that identifies a bank; the number is pri…
Accounting
Systemic recording and reporting of financial transactions.
29 terms
Billing, Insurance Coding Final
Charge Slip
Day sheet
Fee schedule
Ledger
A form used to keep track of charges and payments at the time…
The record of daily transactions in the pegboard or "write-it…
List of charges(fees) for specific procedures that may be per…
A book,card, or computer account used to record financial tra…
Charge Slip
A form used to keep track of charges and payments at the time…
Day sheet
The record of daily transactions in the pegboard or "write-it…
76 terms
Medical Insurance Billing & Coding
abnormal condition that follows and is…
When the patient... (A) has to have a seq…
status are important why?
What is a prosthetic or mechanical dev…
sequelae
status codes
because they may affect the course of treatment and outcome
status code
abnormal condition that follows and is…
sequelae
When the patient... (A) has to have a seq…
status codes
36 terms
Medical Insurance, Billing and Coding
Medicare
F
56
Medicaid
Which of the following insurance claims is the provider's off…
Category II CPT codes consist of 4 digits followed by which a…
What procedure code modifier is used for preoperative managem…
Which health plan should always be treated as the payer of la…
Medicare
Which of the following insurance claims is the provider's off…
F
Category II CPT codes consist of 4 digits followed by which a…
63 terms
Coding, Billing and insurance
The medical office assistant might com…
HOPPA is an abbreviation for hospotal…
Math skills are important when working…
Coding accuracy is very inportent to h…
True
False
True
True
The medical office assistant might com…
True
HOPPA is an abbreviation for hospotal…
False
27 terms
Health Insurance, coding, and billing
Medicare A:
Medicare B:
Medicare C:
What insurance only reimburses therapy…
Inpatient coverage: SNF, Hospital, Acute, Rehab hosp., Hospice
Outpatient: $1,990 for OT a year and $1,900 for ST & PT a year
Medicare advantage: HMO type plans
Tricare West
Medicare A:
Inpatient coverage: SNF, Hospital, Acute, Rehab hosp., Hospice
Medicare B:
Outpatient: $1,990 for OT a year and $1,900 for ST & PT a year
21 terms
Billing insurance & coding
Health care claim
Accuracy
Medical insurance
Deductible
Brainburst meant CMS 1500
Most money we can get
Contract between patient policyholder and the plan
Fixed amount paid once a year
Health care claim
Brainburst meant CMS 1500
Accuracy
Most money we can get
Billing Insurance & Coding (BIC)
Managed Care Organization
Formulary
Benefit
Birthday Rule
Health care business that merger and buyouts, can deliver hea…
Insurance plan's lost of approved prescriptions medications.
Payment for medical services.
Rule that states that the insurance policy of a policyholder…
Managed Care Organization
Health care business that merger and buyouts, can deliver hea…
Formulary
Insurance plan's lost of approved prescriptions medications.
34 terms
Insurance, billing and coding
Coinsurance
COB ... Coordination of benefits
Copayment
DRG... Diagnosis - related group
Percentage owed by the patient for services rendered after de…
procedures insurers use to avoid duplication of payment on cl…
A specified amount the insured must pay toward the charge for…
A prospective payment system developed by Yale University and…
Coinsurance
Percentage owed by the patient for services rendered after de…
COB ... Coordination of benefits
procedures insurers use to avoid duplication of payment on cl…
Insurance,Billing & Coding
Co payments
None
Outpatient Medical Services
Prevent duplication of payment
At the time of service, MA often collect
Under mecicare part B, patients are required to pay an annual :
Medicare Part A does not pay for
The primary purpose of the coordination of benefits is to
Co payments
At the time of service, MA often collect
None
Under mecicare part B, patients are required to pay an annual :
Billing & Coding Insurance Principles
adjustment
allowed amount
benefits
Civilian Health and Medical Program of…
remaining portion after the insurance carrier has met its fin…
the maximum dollar amount the third party will reimburse a pr…
the health insurance coverage a member receives and the speci…
provides health care benefits to individuals with 100% servic…
adjustment
remaining portion after the insurance carrier has met its fin…
allowed amount
the maximum dollar amount the third party will reimburse a pr…
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.
Medical Insurance Billing and Coding
Medical Insurance Billing and Coding
ICD10 Coding
CPT Coding 2015
Health Insurance Today
International Classification of Disease, 9TH Revison, Clinica…
...
...
...
Medical Insurance Billing and Coding
International Classification of Disease, 9TH Revison, Clinica…
ICD10 Coding
...
66 terms
Insurance Coding/Billing
What do the initials ICD stand for?
An ICD 9 code identifies what?
An ICD 10 code identifies what?
How many ICD 9 volumes are there?
International Classification of Diseases
Identifies morbidity data for the indexing of medical records…
Provides increased clinical detail and addresses information…
3
What do the initials ICD stand for?
International Classification of Diseases
An ICD 9 code identifies what?
Identifies morbidity data for the indexing of medical records…
Medical Insurance Billing and Coding
Procedure Code
Level 1 - Current Procedural Terminology
Code Modifiers
Multiple Modifiers (-99)
represent evaluation and management services and diagnostic a…
CPT- used in most states by providers and physicians services…
two or five digit code to give a more accurate description of…
either you can use multiple modifiers either with 2 digit (ex…
Procedure Code
represent evaluation and management services and diagnostic a…
Level 1 - Current Procedural Terminology
CPT- used in most states by providers and physicians services…
25 terms
Billing, Coding and Insurance
ICD-10 coding books:
Volume II of the ICD-10 coding book:
The CPT Coding Book:
The following symbol (*): .
are organized into three volumes.
is the four part alphabetical index.
is divided into six sections.
designates variable pre and postoperative services
ICD-10 coding books:
are organized into three volumes.
Volume II of the ICD-10 coding book:
is the four part alphabetical index.
44 terms
Insurance Billing and Coding
Define Provider...
What is an EOB ?
What is an RA?
What is a Co-Pay?
A physician or other qualified healthcare worker
Explanation of Benefits; sent to the patient and explains how…
Remittance Advice; sent to the provider and explains how clai…
A flat amount paid by the patient at the time of service
Define Provider...
A physician or other qualified healthcare worker
What is an EOB ?
Explanation of Benefits; sent to the patient and explains how…
44 terms
Insurance Billing and Coding
Define Provider...
What is an EOB ?
What is an RA?
What is a Co-Pay?
A physician or other qualified healthcare worker
Explanation of Benefits; sent to the patient and explains how…
Remittance Advice; sent to the provider and explains how clai…
A flat amount paid by the patient at the time of service
Define Provider...
A physician or other qualified healthcare worker
What is an EOB ?
Explanation of Benefits; sent to the patient and explains how…
20 terms
Billing, Coding & Insurance
coding systems are:... a. used to place v…
ICD-9 coding books:... a. are organized i…
volume II of the ICD-9 coding book:... a.…
the CPT coding book:... a. provides a 5 d…
d
a
a
c
coding systems are:... a. used to place v…
d
ICD-9 coding books:... a. are organized i…
a
60 terms
Insurance Coding Billing Final
What do the initials ICD stand for?
An ICD-10 code identifies what?
The ICD-10 coding system consists of t…
Which coding system is used primarily…
International Classification of Disease
Diagnosis
The ICD-10-CM and the ICD-10-PCS
ICD-10-PCS
What do the initials ICD stand for?
International Classification of Disease
An ICD-10 code identifies what?
Diagnosis
Insurance Billing and Coding
What does the abbreviation RA stand for?
What do primary payers issue to detail…
When is it not necessary to submit a c…
What does the abbreviation EMC stand f…
Remittance advice
RA
When the payer handles COB
Electronic Media Claim
What does the abbreviation RA stand for?
Remittance advice
What do primary payers issue to detail…
RA
Health Insurance, Coding, and Billing
Medicare A
Medicare B
Medicare C
International Classification of Diseas…
Hospital coverage, acute care, SNF, Rehab hospital, hospice
Outpatient; cap of 1990/year for OT; 1900 for PT and ST
Medicare advantage-HMO type plans
WHO
Medicare A
Hospital coverage, acute care, SNF, Rehab hospital, hospice
Medicare B
Outpatient; cap of 1990/year for OT; 1900 for PT and ST
insurance and billing and coding final
Premiums
Policyholder
Advanced beneficiary notice (ABN)
Copay
periodic fee that a FFS policyholder must pay to the insuranc…
A person in whose name an insurance policy is held who pays.
CMS-R-131 is a standardized notice you or your designee must…
fixed amount of a total medical bill that YOU pay collect at…
Premiums
periodic fee that a FFS policyholder must pay to the insuranc…
Policyholder
A person in whose name an insurance policy is held who pays.
31 terms
Medical Billing and coding - insurance terms
Assignments of benefits
Accept assignment
New patient
Established patient
Reimbursement is directly sent from the payer to the provider
The provider agrees to accept what the insurance company appr…
Us one who has not received professional service from the phy…
One who received professional service from the physician or a…
Assignments of benefits
Reimbursement is directly sent from the payer to the provider
Accept assignment
The provider agrees to accept what the insurance company appr…
Insurance Coding & Billing #102
Tricare
Medicaid
Medicare
Premium
Insurance for military dependents
Insurance for the indigent (Not in AZ) (Medi-Cal in California)
Insurance for the aged, totally disabled & blind
Payment made to keep the insurance policy force
Tricare
Insurance for military dependents
Medicaid
Insurance for the indigent (Not in AZ) (Medi-Cal in California)
CODING AND INSURANCE BILLING
federal insurance program for elderly…
term for an insurance claim for a medi…
type of insurance for work-related inj…
insurance claims which have a greater…
medicare
crossover
workers' compensation
paper claims
federal insurance program for elderly…
medicare
term for an insurance claim for a medi…
crossover
Billing, Coding, and Insurance in GC
What are two categories of insurance?
What are three kinds of government ins…
What do CMS and CLIA do?
What is a revenue cycle?
Private vs. Government
1.) Medicaid: Limited income, covers children, pregnant women…
CLIA is quality assurance for implementing CMS to oversee all…
How we turn medical procedure into a billable claim to reimbu…
What are two categories of insurance?
Private vs. Government
What are three kinds of government ins…
1.) Medicaid: Limited income, covers children, pregnant women…
Insurance Billing & Coding Chapter 12
When a patient is covered by a large e…
When a child who is covred by two or m…
When an insurance company uses the pat…
When the CMS-1500 claim requires space…
EGHP
whose birthday occurs first in the year
contains the ID number without hyphens or spaces
MM DD YYYY
When a patient is covered by a large e…
EGHP
When a child who is covred by two or m…
whose birthday occurs first in the year
43 terms
NHA INSURANCE TERMS FOR MEDICAL BILLING & CODING
assignment of benefits
accept assignment
new patient
established patient
reimbursement is directly sent from the payer to the provider
the provider agrees to accept what the insurance company appr…
one who has not received professional services from the physi…
one who has received professional services from the physician…
assignment of benefits
reimbursement is directly sent from the payer to the provider
accept assignment
the provider agrees to accept what the insurance company appr…
Insurance Billing & Coding Chapter 14
CMS is responsible for administering t…
Medicare part ______ reimburses instit…
Which is a characteristic of Medicare…
A Medicare benefit period is defined a…
Medicare
A
Eligible individuals are automatically enrolled, or they appl…
The patient has been out of the hospital for 60 consecutive d…
CMS is responsible for administering t…
Medicare
Medicare part ______ reimburses instit…
A
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.
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.
Insurance and Coding- Chapter 1 - Insurance and Billing Procedures
In addition to medical data, the medic…
medical ethics will typically address…
how do you correct an error in a patie…
insurance policy
personal data, financial data, social data
conduct
draw a single line through it
a legally enforceable document composed by an insurance compa…
In addition to medical data, the medic…
personal data, financial data, social data
medical ethics will typically address…
conduct
Dental codes for Billing Insurance
Kathriel Finley
Diagnostic D0100-D0999
Preventive D1000-D1999
Restorative D2000-D3999
Dental Codes for Billing Insurance... November 2, 2016
Clinical oral evaluations, radio-graphs/ diagnostic imagining…
Dental prophylaxis, topical fluoride treatment, nutritional c…
Amalgam restorations, resin-based composite restorations, gol…
Kathriel Finley
Dental Codes for Billing Insurance... November 2, 2016
Diagnostic D0100-D0999
Clinical oral evaluations, radio-graphs/ diagnostic imagining…
21 terms
Insurance and Coding- Chapter 1 - Insurance and Billing Procedures
In addition to medical data, the medic…
medical ethics will typically address…
how do you correct an error in a patie…
insurance policy
personal data, financial data, social data
conduct
draw a single line through it
a legally enforceable document composed by an insurance compa…
In addition to medical data, the medic…
personal data, financial data, social data
medical ethics will typically address…
conduct
13 terms
Dental Codes for Billing and Insurance
Marcella Pryor
Diagnostic D0100-D0999
Preventive D1000-D1999
Restoration D2000-D2999
Dental Codes for Billing and Insurance... November 2, 2016
Clinical oral evaluations, radiographs/ diagnostic imaging, t…
Dental prophylaxis, topical fluoride treatment, space mainten…
Amalgam restorations, resin-based composite restorations, gol…
Marcella Pryor
Dental Codes for Billing and Insurance... November 2, 2016
Diagnostic D0100-D0999
Clinical oral evaluations, radiographs/ diagnostic imaging, t…
43 terms
Insurance Code Billing
What do the initials ICD stand for?
An ICD 9 & 10 code identifies what?
How many ICD 9 volumes are there?
Which volume is used primarily in hosp…
International Classification of Diseases
Diagnosis
There are 3 volumes in the ICD-9 manual
Volume 3
What do the initials ICD stand for?
International Classification of Diseases
An ICD 9 & 10 code identifies what?
Diagnosis
100 terms
Medical Billing, Coding, & Insurance Key Terms
Abuse
Add-on codes
Adjustment
Admitting Clerk
Improper billing practices that result in financial benefit t…
CPT codes with a + symbol in front, used to specify procedure…
A positive or negative change to a patient's account balance.…
Clerk who enters patient's demographic information into a com…
Abuse
Improper billing practices that result in financial benefit t…
Add-on codes
CPT codes with a + symbol in front, used to specify procedure…
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.
17 terms
Insurance bill n coding
Aapc
Ahima
Cms
coding
American academy of prodessional coders.
American health information management association
Administrative agency within the federal department of health…
Codes to diagnoses, procedure and services
Aapc
American academy of prodessional coders.
Ahima
American health information management association
60 terms
Medical Billing, Coding, and Insurance-Chapter 7
HIPAA X12 837 Health Care Claim:Profes…
CMS-1500
National Uniform Claim Committee
CMS-1500 (08/05)
is a form used to send a claim for physician services to prim…
paper claim for physician services.
organization responsible for claim content.
current paper claim approved by the NUCC.
HIPAA X12 837 Health Care Claim:Profes…
is a form used to send a claim for physician services to prim…
CMS-1500
paper claim for physician services.
39 terms
Medical Billing, Coding, and Insurance Chapter 2
A medical record must document what fo…
Explain the term medical professional…
List 8 advantages of EHRs over paper r…
List the four types of information in…
A patient's health history, examinations, tests, and results…
Healthcare providers are legally responsible for providing a…
1. Immediate access to health information.... 2. Computerized ph…
1. The chief complaint.... 2. The history and physical examinati…
A medical record must document what fo…
A patient's health history, examinations, tests, and results…
Explain the term medical professional…
Healthcare providers are legally responsible for providing a…
13 terms
Insurance/Coding/Billing chapter 45
established patience
inpatient
modifier
morphology
a patient who has been seen by one of the physicians in the p…
a patient who has been formally admitted to a health care fac…
an addition to CPT code that indicates unusual circumstances…
the study of structure and form
established patience
a patient who has been seen by one of the physicians in the p…
inpatient
a patient who has been formally admitted to a health care fac…
18 terms
Insurance coding & billing terms #1
Tricare
Medicaid/medi-cal
Medicare
Premium
Insurance for military dependents
Insurance for the indigent, low income , and disabled individ…
Insurance for aged(65+), disabled, and blind
Payment made to keep the insurance active
Tricare
Insurance for military dependents
Medicaid/medi-cal
Insurance for the indigent, low income , and disabled individ…
Insurance Billing Coding UNIT 1
cash flow
Accounts receivable
Revenue cycle management
Health information technology
the movement of the monies into or out of a business
to pay the practice's operating expenses, such as for rent, s…
the process of making sure that sufficient monies flow into t…
computer information systems that record, store and manage pa…
cash flow
the movement of the monies into or out of a business
Accounts receivable
to pay the practice's operating expenses, such as for rent, s…
Insurance Billing Coding Unit 2
What are the two main organization com…
true
true
false
alphabetic index and tabular list
One difference between ICD-9 and ICD-10 is that ICD-10 descri…
ICD-10 CM was originally planned to be implemented on October…
In diagnostic coding, the coexisting conditions are coded fir…
What are the two main organization com…
alphabetic index and tabular list
true
One difference between ICD-9 and ICD-10 is that ICD-10 descri…
48 terms
insurance billing n coding final
Inter- Related System
Two main types of Managed Care
PPO
HMO
Managed Care
PPO(preferred provider organization)... HMO (health maintenance…
preferred provider organization
health maintenance organization
Inter- Related System
Managed Care
Two main types of Managed Care
PPO(preferred provider organization)... HMO (health maintenance…
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