Study sets matching "insurance coding"

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Study sets matching "insurance coding"

90 terms
Insurance and Coding
Policy
Insurer
Indemnify
Preventative Medicine
Insurance- A written agreement between two parties (or entiti…
The Insuring Party
Reimburse
Practice that focuses on overall health and the prevention of…
Policy
Insurance- A written agreement between two parties (or entiti…
Insurer
The Insuring Party
medical insurance billing and coding
english
billing codes
cpt codes
medical insurance
...
icd 10
cpt 9
health insurance today
english
...
billing codes
icd 10
12 terms
Insurance Coding
diagnostic
preventive
restorative
endodontics
D0100-D0999
D1000-D1999
D2000-D2999
D3000-D3999
diagnostic
D0100-D0999
preventive
D1000-D1999
10 terms
Insurance & Coding
ICD-10
ICD-9 has ___ volumes.
CPT codes
Medicare and Medicaid Anti-fraud Act o…
Started 10-1-15... Allows for 55,000 more conditions than ICD-9
3... Tabular list of disease ... Alphabetical list of disease ... Tabu…
Each service is identified by a 5 digit code. ... Simplifies the…
Prohibits intentional misrepresentation or concealment of fac…
ICD-10
Started 10-1-15... Allows for 55,000 more conditions than ICD-9
ICD-9 has ___ volumes.
3... Tabular list of disease ... Alphabetical list of disease ... Tabu…
Coding and insurance
Medicare
Crossover
Worker compensation
Paper claim
Federal insurance program for elderly persons or persons with…
Term for an insurance claim for a Medicare and medical pt
Type of insurance for work related injuries
Insurance claims that have a greater chance of rejection
Medicare
Federal insurance program for elderly persons or persons with…
Crossover
Term for an insurance claim for a Medicare and medical pt
34 terms
Insurance and Coding
Policyholder
Carrier
Insured
Premium
Pays a premium and is the person who holds the medical contra…
The insurance company
The person paying the bill/premium and primarily covered by t…
The rate charged for the policy (the bill)
Policyholder
Pays a premium and is the person who holds the medical contra…
Carrier
The insurance company
19 terms
Insurance Code
Shall
May
Burglary
Roberry
Mandatory
Permissive
You steal when no one is present
You rob while Robert is present
Shall
Mandatory
May
Permissive
159 terms
Insurance and Coding
What is an insurance carrier?
Which of the following definitions bes…
What is the term for the fee patients…
How often must a patient meet the dedu…
A company that provides insurance plans
A contract protecting patients from financial loss in case of…
Premium
Each year
What is an insurance carrier?
A company that provides insurance plans
Which of the following definitions bes…
A contract protecting patients from financial loss in case of…
insurance and coding
What is an insurance carrier?
Which of the following definitions bes…
What is the term for the fee patients…
How often must a patient meet the dedu…
A company that provides insurance plans
A contract protecting patients from financial loss in case of…
Premium
Each year
What is an insurance carrier?
A company that provides insurance plans
Which of the following definitions bes…
A contract protecting patients from financial loss in case of…
Insurance and Coding
3 government programs used to pay for…
Who qualifies for Medicaid
Who qualifies for Medicare
Two major categories of insurance are:
Medicare, Medicaid, and tricare/chanpva
Low-income, disabled, foster children, children born with dis…
Ages 65 & up
Fee for service and managed care
3 government programs used to pay for…
Medicare, Medicaid, and tricare/chanpva
Who qualifies for Medicaid
Low-income, disabled, foster children, children born with dis…
32 terms
Insurance Codes
0120
0150
0180
0210
Periodic Oral Evaluation
Comprehensive Oral Evaluation
Comprehensive Periodontal Evaluation
FMS
0120
Periodic Oral Evaluation
0150
Comprehensive Oral Evaluation
Medical insurance \ medical insurance coding
Adjustment
Assignment of benefits
Beneficiary
Coordination of benefits cob
Increases or decreases to patient accounts not due to charges…
Signing over benefits by the beneficiary to another party
Person under a policy eligible to receive benefits
The provision of an insurance contract that limits benefits t…
Adjustment
Increases or decreases to patient accounts not due to charges…
Assignment of benefits
Signing over benefits by the beneficiary to another party
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
Medical Insurance/Medical Insurance Coding
Adjustment
Assignment of Benefits
Beneficiary
Coordination of Benefits (COB)
Increases/decreases to patient accounts not due to charges in…
Signing over of benefits by the beneficiary to another party
Person under a policy eligible to receive benefits
Provision of an insurance contract that limits benefits to 10…
Adjustment
Increases/decreases to patient accounts not due to charges in…
Assignment of Benefits
Signing over of benefits by the beneficiary to another party
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…
8 terms
INSURANCE CODES
Diagnostic insurance code
Preventive insurance code
Restorative insurance code
Endodontics insurance code
D0100-D0999
D1000-D1999
D2000-D2999
D3000-D3999
Diagnostic insurance code
D0100-D0999
Preventive insurance code
D1000-D1999
5 terms
insurance codes
D0120
D0140
D0150
D0160
Periodic oral exam
Problem focused-limited
Comprehensive oral exam
Problem focused-detailed/extensive
D0120
Periodic oral exam
D0140
Problem focused-limited
5 terms
insurance codes
D1110
D4910
D4341
D4342
Dental cleaning preformed ... Scaled and polished teeth ... Remove…
Periodontal supportive care ... After pt. has done perio surgery…
Initial therapy for perio diagnosed patient ... SRP teeth and cr…
Perio debridement for perio diagnosed patient ... SRP teeth and…
D1110
Dental cleaning preformed ... Scaled and polished teeth ... Remove…
D4910
Periodontal supportive care ... After pt. has done perio surgery…
20 terms
Insurance codes
Inter-oral. Periapical first film
Sealant per tooth
Pulp Cap direct
Prophy adult
D0220
D1351
D3110
D1110
Inter-oral. Periapical first film
D0220
Sealant per tooth
D1351
18 terms
Insurance Codes
D 0120
D 0140
D 0150
D 0160
Periodic oral evaluation to determine if there has been any c…
limited oral evaluation
Comprehensive oral evaluation done on new clients or clients…
Detailed and extensive oral evaluation based on a specific pr…
D 0120
Periodic oral evaluation to determine if there has been any c…
D 0140
limited oral evaluation
97 terms
Insurance Codes
D1110
D1120
D1208
D1206
Adult Dentition Prophy
Child Prophy
Fluoride Gel/Rinse/Tray
Fluroide Varnish
D1110
Adult Dentition Prophy
D1120
Child Prophy
Codes for insurance
Evaluation and management(E+M)
Anesthesiology
Surgery
Radiolody
99201-99499
00100-01999
10021-69990
70010-79999
Evaluation and management(E+M)
99201-99499
Anesthesiology
00100-01999
22 terms
Insurance codes
0120
0210
0274
0272
Periodic oral exam
Full mouth series xr
4 bite wing xr
2 bite wing xr
0120
Periodic oral exam
0210
Full mouth series xr
Insurance Codes
periodic oral exam
limited exam (emergency)
evaluation under 3 yo
new pt exam
0120
0140
0145
0150
periodic oral exam
0120
limited exam (emergency)
0140
Chapter one insurance and coding
Benefits
Coinsurance
Who is coinsurance paid by
Copayment
Health plan payment for covered services
Portion of charges an insured person must pay for health care…
Policy holder
Amount a beneficiary must pay at the time of a health care en…
Benefits
Health plan payment for covered services
Coinsurance
Portion of charges an insured person must pay for health care…
Insurance Code
Under Section 6002 of the state code,…
Under Section 6002 of the state code,…
Under section 6002 of the state code a…
Under section 6002 of the state code,…
Fire Alarm Technician, Residential Fire Alarm Superintendent,…
a single-family or two-family dwelling.
True
The supplier or installing contractor
Under Section 6002 of the state code,…
Fire Alarm Technician, Residential Fire Alarm Superintendent,…
Under Section 6002 of the state code,…
a single-family or two-family dwelling.
Medical coding and insurance
Assignment of Insurance Benefits
Beneficiary
Birthday Rule
Capitation
A statement authorizing the insurance company to pay benefits…
The person receiving the benefits of an insurance policy
The rule governing the hierarchy of an insurance policy
A method of payment for health services in which an individua…
Assignment of Insurance Benefits
A statement authorizing the insurance company to pay benefits…
Beneficiary
The person receiving the benefits of an insurance policy
16 terms
Insurance Codes
92004
92014
92015
92310
Comprehensive New Patient
Comprehensive Est. Patient
Refraction
Contact Lens Fitting
92004
Comprehensive New Patient
92014
Comprehensive Est. Patient
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…
44 terms
Chapter 6 Insurance and coding
accepting assignment
allowed charge
assignment of benefits
balance billing
The process where in health care providers agree to accept th…
the maximum amount the payer will reimburse for each procedur…
instructions to an insurance company about whom or wherever t…
Practice of billing patients for any balance left after deduc…
accepting assignment
The process where in health care providers agree to accept th…
allowed charge
the maximum amount the payer will reimburse for each procedur…
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.
34 terms
Insurance and coding ch3
A patient that has not been seen in th…
NP is abbreviated for?
A patient who has been seen in the las…
EP is abbreviated for?
New patient
New patient
Established patient
Established patient
A patient that has not been seen in th…
New patient
NP is abbreviated for?
New patient
124 terms
MA - Medical Insurance & Coding
fee-for-service care
advance beneficiary notice (ABN)
allowed amount
assignment of benefits
expensive premiums, but more freedom to pick providers and st…
required by medicare when a service is provided to a benefici…
the maximum amount an insurer will pay for any given service
the authorization, by signature of the patient, for payment t…
fee-for-service care
expensive premiums, but more freedom to pick providers and st…
advance beneficiary notice (ABN)
required by medicare when a service is provided to a benefici…
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
26 terms
Medical insurance/ medical insurance coding
Adjustment
Assignment of benefits
Beneficiary
Coordination of benefits
Increase or decrease to patient accounts not due to charges i…
Signing over benefits by the beneficiary to another party
Person under a policy eligible to receive benefits
The provision of an insurance contract that limits benefits t…
Adjustment
Increase or decrease to patient accounts not due to charges i…
Assignment of benefits
Signing over benefits by the beneficiary to another party
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…
Chapter 7: Insurance and Coding
insured
premium
coordination of benefits
greater coverage
the person who takes out the insurance policy
the rate charged to the policyholder for the insurance policy
clause in insurance policies which states that the insured wh…
more expensive the plan
insured
the person who takes out the insurance policy
premium
the rate charged to the policyholder for the insurance policy
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
29 terms
Chapter 3 Insurance and Coding
new patient(NP)
established patient(EP)
referring physician
network
patient who has not seen a provider within the past three yea…
patient who has seen a provider within the past three years.
physician who transfers care of a patient to another physician.
group of providers in managed care organization.
new patient(NP)
patient who has not seen a provider within the past three yea…
established patient(EP)
patient who has seen a provider within the past three years.
28 terms
Medical Insurance/ Medical Insurance Coding
Adjustment
Assignment of benefits
Beneficiary
Coordinator of benefits (COB)
increases or decreases to patient accounts not due to charges…
signing over of benefits by the beneficiary to another party
person under a policy eligible to receive benefits
the provision of an insurance contract that limits benefits t…
Adjustment
increases or decreases to patient accounts not due to charges…
Assignment of benefits
signing over of benefits by the beneficiary to another party
66 terms
Insurance & Coding Specialist Review and Terminology
to know procedural and diagnostic coding
the state
conduct
confidential
In order to work completely as a medical claims specialist in…
Information that must be included in the medical record is de…
Medical ethics will typically address standards of
Everything that a medical claims specialist learns about a pa…
to know procedural and diagnostic coding
In order to work completely as a medical claims specialist in…
the state
Information that must be included in the medical record is de…
136 terms
NCCT Chapter 3 Insurance and Coding
Billing for services not provided is a…
Claims for services deemed not medical…
For the physician involved, Medicare o…
Misconduct that occurs within a physic…
fraud
abuse
exclusion from program participation
malpractice
Billing for services not provided is a…
fraud
Claims for services deemed not medical…
abuse
57 terms
NCCT 2 Insurance and coding
An unintended reaction to a drug is ca…
The medical term for high blood preasu…
proximal and distal refer to
Plantar flexion is a movement of the
adversse effect
hypertension
proximity
foot
An unintended reaction to a drug is ca…
adversse effect
The medical term for high blood preasu…
hypertension
19 terms
NCCT Insurance and coding specialist
In order to work competently as a medi…
In addition to medical data, the medic…
Medical ethics will typically address…
Everything that a medical claims speci…
To know procedural and diagnostic coding
Personal data,financial data,social data,
Conduct
Confidential
In order to work competently as a medi…
To know procedural and diagnostic coding
In addition to medical data, the medic…
Personal data,financial data,social data,
Insurance Coding Chapter 3
Accident
Active Work
Actively-at-work
Acts of Third Parties (ATP)
an unintentional injury that has a specific time, date, and p…
refers to actively working in a position for a full day
An "Actively-at-work" stipulation states that a person must b…
Acts of Third Parties (ATP) and subrogation are provisions th…
Accident
an unintentional injury that has a specific time, date, and p…
Active Work
refers to actively working in a position for a full day
27 terms
Insurance & Coding MidTerm
co-insurance
3rd party payer
medicaid
liability insurance
portion of a charge that an insured person pays based on a pe…
an individual/organization not directly involved in an encoun…
indigent, lower income
a policy that covers loss or injury to a 3rd party caused by…
co-insurance
portion of a charge that an insured person pays based on a pe…
3rd party payer
an individual/organization not directly involved in an encoun…
Chapter 2 Insurance Coding
Centers for Medicare and Medicaid Serv…
CMS-1500
Current Dental Terminology (CDT)
Current Procedural Terminology (CPT)
formerly known as the Health Care Financing Administration (H…
a standardized form, approved by the American Medical Associa…
a reference book that provides language for sental healthcare…
is a systematic listing for coding the procedures or services…
Centers for Medicare and Medicaid Serv…
formerly known as the Health Care Financing Administration (H…
CMS-1500
a standardized form, approved by the American Medical Associa…
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
57 terms
NCCT 2 Insurance and coding
An unintended reaction to a drug is ca…
The medical term for high blood preasu…
proximal and distal refer to
Plantar flexion is a movement of the
adversse effect
hypertension
proximity
foot
An unintended reaction to a drug is ca…
adversse effect
The medical term for high blood preasu…
hypertension
19 terms
NCCT Insurance and coding specialist
In order to work competently as a medi…
In addition to medical data, the medic…
Medical ethics will typically address…
Everything that a medical claims speci…
To know procedural and diagnostic coding
Personal data,financial data,social data,
Conduct
Confidential
In order to work competently as a medi…
To know procedural and diagnostic coding
In addition to medical data, the medic…
Personal data,financial data,social data,
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