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Study sets matching "insurance medical billing"

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Study sets matching "insurance medical billing"

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
63 terms
Medical Insurance Billing Procedures
access rights
accounting cycle
accounts receivable (AR)
adjudication
security option that determines the areas of the program a us…
the flow of financial transactions in a business
monies that are flowing into a business
a series of steps that determine whether a claim should be paid
access rights
security option that determines the areas of the program a us…
accounting cycle
the flow of financial transactions in a business
15 terms
Medical Insurance and Billing
Diagnostic Statement
Chronic
Abstract
Acute
Information about a patient's diagnosis or diagnoses that has…
A disease that manifests over a long period time medical trea…
A summary of the diagnostic statement and or procedures and s…
The initial assessment and treatment of the disease, conditio…
Diagnostic Statement
Information about a patient's diagnosis or diagnoses that has…
Chronic
A disease that manifests over a long period time medical trea…
30 terms
Medical Insurance Billing Test!!!
Another name for an electronic transmi…
which is a type of insurance coverage…
Which of the following covers medicati…
the insurance company is contacted to…
EDI
WC
Medicare Part D
false
Another name for an electronic transmi…
EDI
which is a type of insurance coverage…
WC
74 terms
Medical Billing Insurance Ch. 3
cash flow
revenue cycle management (RCM)
Pre-Claim section of medical billing c…
New Patient (NP)
movement of monies into or out of a business
the actions that ensure the provider receives the maximum app…
processing encounters for billing purposes
patient who has not seen a provider withing the past three ye…
cash flow
movement of monies into or out of a business
revenue cycle management (RCM)
the actions that ensure the provider receives the maximum app…
63 terms
Medical Insurance Billing Procedures
access rights
accounting cycle
accounts receivable (AR)
adjudication
security option that determines the areas of the program a us…
the flow of financial transactions in a business
monies that are flowing into a business
a series of steps that determine whether a claim should be paid
access rights
security option that determines the areas of the program a us…
accounting cycle
the flow of financial transactions in a business
Medical Billing Insurance Test 2 Review @ LIBI
MCR
MCD
allowed amount
Part A
medicare
medicaid
the amount deemed appropriate to pay for svcs rendered by an…
covers hospital
MCR
medicare
MCD
medicaid
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
57 terms
Medical Insurance and Billing Terminology
Birthday Rule
Explanation of Benefits
Coordination of benefits
fee-for-service
The rule stating that the primary insurance plan for all depe…
Document explaining the total amount of the claim, the amount…
The legal clause limiting the total payments from all insuran…
The traditional health plan that reimburses policyholders for…
Birthday Rule
The rule stating that the primary insurance plan for all depe…
Explanation of Benefits
Document explaining the total amount of the claim, the amount…
26 terms
Medical billing and insurance vocabulary
Guarantor
Covered entity (CE)
Preauthorization
Write off
Person who is financially responsible for the bill
Health plan clearinghouse or provider who transmits any healt…
Prior authorization from a player for devices to be provided
To deduct an amount from a patient's account
Guarantor
Person who is financially responsible for the bill
Covered entity (CE)
Health plan clearinghouse or provider who transmits any healt…
20 terms
Medical Insurance and Billing Abbreviations
p
s
AMA
BRP
after
without
against medical advice
bathroom privileges
p
after
s
without
16 terms
Medical Insurance and Billing
Itemization
Third Party Payer
Appeals Process
Two Major Types Of Medical Billing
listing of each one
Someone else that pays
Requesting a review. A formal request for the insurance plan…
Professional Services... Physician Services
Itemization
listing of each one
Third Party Payer
Someone else that pays
23 terms
Medical Insurance Billing
physician is the first party
PCP's
medicare
CMS
can not charge a different amount to each insurance company f…
primary care provider who belongs to a network of providers a…
for people over 65, the disabled, and end-stage renal disease…
ADMINISTERED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES
physician is the first party
can not charge a different amount to each insurance company f…
PCP's
primary care provider who belongs to a network of providers a…
63 terms
Medical Insurance Billing Procedures
access rights
accounting cycle
accounts receivable (AR)
adjudication
security option that determines the areas of the program a us…
the flow of financial transactions in a business
monies that are flowing into a business
a series of steps that determine whether a claim should be paid
access rights
security option that determines the areas of the program a us…
accounting cycle
the flow of financial transactions in a business
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…
13 terms
Insurance Info/Medical Billing
benefits
premiums
affordable care act
deductible
payments the plan makes to cover all or part of covered medic…
these are the payments you make for your insurance; rates are…
introduced some changes in how premiums may be set: a premium…
this is the amount you're responsible to pay for covered medi…
benefits
payments the plan makes to cover all or part of covered medic…
premiums
these are the payments you make for your insurance; rates are…
26 terms
Ross Medical Insurance and Billing
ABN
primary carrier
secondary payer
physician fee schedule
is a waver the patients must sign if there is a possibility t…
is billed first and the most amount
is billed second and the lowest amount
amount charged for each procedure
ABN
is a waver the patients must sign if there is a possibility t…
primary carrier
is billed first and the most amount
Medical insurance and billing.
Types of scheduling
Block
Wave
Modified wave
block, wave, modified wave
patients schedules at certain times, usually every 20 minutes
patients scheduled at the same time, seen as they arrive
2 on the hour 1 on the half hour
Types of scheduling
block, wave, modified wave
Block
patients schedules at certain times, usually every 20 minutes
25 terms
medical billing theory & insurance
a.c
b.i.d
ID
IM
before meals
twice a day
injection into the middle layer of the skin
injection directly into muscle tissue
a.c
before meals
b.i.d
twice a day
23 terms
Medical Insurance Billing
physician is the first party
PCP's
medicare
CMS
can not charge a different amount to each insurance company f…
primary care provider who belongs to a network of providers a…
for people over 65, the disabled, and end-stage renal disease…
ADMINISTERED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES
physician is the first party
can not charge a different amount to each insurance company f…
PCP's
primary care provider who belongs to a network of providers a…
10 terms
Medical insurance and billing.
Types of scheduling
Block
Wave
Modified wave
Block, Wave, Modified wave
Patients scheduled at certain times, usually every 15-20 minu…
Patients scheduled at the same time, seen as they arrive.
Two on the hour and one on the half hour.
Types of scheduling
Block, Wave, Modified wave
Block
Patients scheduled at certain times, usually every 15-20 minu…
39 terms
medical insurance and billing procedures
In order to work competently as a medi…
Information that must be included in t…
Medical ethics will typically address…
Everything that a medical claims speci…
to know procedural and diagnostic coding
the state
conduct
confidential
In order to work competently as a medi…
to know procedural and diagnostic coding
Information that must be included in t…
the state
12 terms
Medical insurance and billing.
Types of scheduling
Block
Wave
Modified wave
block, wave, modified wave
patients schedules at certain times, usually every 20 minutes
patients scheduled at the same time, seen as they arrive
2 on the hour 1 on the half hour
Types of scheduling
block, wave, modified wave
Block
patients schedules at certain times, usually every 20 minutes
29 terms
MEDICAL BILLING INSURANCE
coinsurance
capitation
copayment
fee-for-service
the portion of charges the insured person must pay after the…
prepayment method from insurance covers services to enrolled…
the amount a healthcare requires the patient to pay at the ti…
a method of charging for which providers payments by insuranc…
coinsurance
the portion of charges the insured person must pay after the…
capitation
prepayment method from insurance covers services to enrolled…
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
Medical Insurance Billing
Coordination of benefits
Copayment
NPI
Preauthorization
Determines which policy is primary and which is secondary
Fixed payment made at the time of service determined by insur…
10 digit number assigned to each provider
Obtaining permission for coverage from the patient's insuranc…
Coordination of benefits
Determines which policy is primary and which is secondary
Copayment
Fixed payment made at the time of service determined by insur…
12 terms
Medical insurance and billing.
Types of scheduling
Block
Wave
Modified wave
block, wave, modified wave
patients schedules at certain times, usually every 20 minutes
patients scheduled at the same time, seen as they arrieve
two on the hour one on the half hour
Types of scheduling
block, wave, modified wave
Block
patients schedules at certain times, usually every 20 minutes
12 terms
Medical insurance and billing.
Types of scheduling
Block
Wave
Modified wave
Block, Wave, Modified wave
Patients scheduled at certain times, usually every 15-20 minu…
Patients scheduled at the same time, seen as they arrive.
Two on the hour and one on the half hour.
Types of scheduling
Block, Wave, Modified wave
Block
Patients scheduled at certain times, usually every 15-20 minu…
11 terms
MEDICAL INSURANCE BILLING
CMS
CMS-1500
EDI
Vertification of Benefits
What agency administers the medicare program
A uniform billing format for medical claims
Another name for an electronic transmission
Determining whether a patient is eligible for coverage
CMS
What agency administers the medicare program
CMS-1500
A uniform billing format for medical claims
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
30 terms
MEDICAL INSURANCE BILLING
What agency administers the Medicare p…
A uniform billing format for medical c…
Another name for an electronic transmi…
Determining whether a patient is eligi…
CMS
CMS-1500
EDI
Verification of Benefits
What agency administers the Medicare p…
CMS
A uniform billing format for medical c…
CMS-1500
37 terms
medical: insurance, billing, etc.
medical insurance
insurance policy
deductible
coverage
seguro médico
póliza
deducible
cobertura
medical insurance
seguro médico
insurance policy
póliza
36 terms
Medical Billing Insurance
Clinical Laboratory Improvement
CMS-1500
coinsurance
coinsurance
established quality standards for all laboratory testing to e…
form used to submit Medical claims; previously called the HCF…
the percentage the patient pays for covered services after th…
also called coinsurance payment
Clinical Laboratory Improvement
established quality standards for all laboratory testing to e…
CMS-1500
form used to submit Medical claims; previously called the HCF…
42 terms
Medical Billing: Insurance
Manage Care Organizations
Managed Care
MCOs are
3 Types of Managed Care Plans
MCOs
Ensure that care is rendered by the most appropriate provider…
Organizations (usually health insurance carriers) that contac…
Hmos,PPos,POSs
Manage Care Organizations
MCOs
Managed Care
Ensure that care is rendered by the most appropriate provider…
19 terms
Medical insurance billing
What agency sdminksters the medicare p…
A uniform billing format for medical c…
Another name for an electronic transmi…
Determining whether a patient is eligi…
CMS
CMS-1500
EDI
Verification of benefits
What agency sdminksters the medicare p…
CMS
A uniform billing format for medical c…
CMS-1500
5 terms
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
...
39 terms
Medical Insurance and Billing Procedures
In order to work completly as a medica…
In addition to medical data, the medic…
Medical ethics will typcally adress st…
Everythnig that a medical claims speci…
To know procedural and diagnostic coding.
Personal, Financial, and Social data.
Conduct.
Confidential.
In order to work completly as a medica…
To know procedural and diagnostic coding.
In addition to medical data, the medic…
Personal, Financial, and Social data.
39 terms
Medical Insurance and Billing Procedures
to know procedural and diagnostic codi…
all answers are correct... personal data,…
conduct.
confidential.
In order to work competently as a medical claims specialist i…
In addition to medical data, the medical record may include _…
Medical ethics will typically address standards of _______
Everything that a medical claims specialist learns about a pa…
to know procedural and diagnostic codi…
In order to work competently as a medical claims specialist i…
all answers are correct... personal data,…
In addition to medical data, the medical record may include _…
35 terms
Medical Insurance Billing
What part of Medicare covers physician…
Purpose of the Advance Beneficiary Not…
Can providers charge different amounts…
Uniform billing format for claims
Medicare Part B
It notifies the patients that the service may not be paid by…
NO
CMS-1500
What part of Medicare covers physician…
Medicare Part B
Purpose of the Advance Beneficiary Not…
It notifies the patients that the service may not be paid by…
13 terms
medical billing and insurance d
capitation
5 types of important information (5)
in order to succeed in medicine a MA m…
requirements for success (7)
fixed payment covering provider services for specific period
pre registration... med hx... insurance debt... acknowledgement of npp…
positive attitude... good clean appearance... good attendance... show…
knowledge of a&p, med term, and billing and coding... attention…
capitation
fixed payment covering provider services for specific period
5 types of important information (5)
pre registration... med hx... insurance debt... acknowledgement of npp…
13 terms
Medical insurance billing test
Medicare
Medicaid
Medicare that covers MCO
Medicare that covers physician visits
Insurance for people over 65
Insurance for low income people
Part C
Part B
Medicare
Insurance for people over 65
Medicaid
Insurance for low income people
42 terms
Medical Insurance Billing Ch. 1
HCPCS
CPT
AAPC
Bonding Insurance
Healthcare Common Procedure Coding System... Procedures items d…
Current Procedural Terminology... Where procedure codes come from
American Academy of Professional Coders... National association…
An insurance agreement that guarantees repayment for financia…
HCPCS
Healthcare Common Procedure Coding System... Procedures items d…
CPT
Current Procedural Terminology... Where procedure codes come from
35 terms
Medical Insurance Billing
What part of Medicare covers physician…
Can providers charge different amounts…
This is known as the uniform billing f…
What is the insurance that covers depe…
Part B
No
CMS-1500
tricare
What part of Medicare covers physician…
Part B
Can providers charge different amounts…
No
32 terms
Medical Insurance Billing
What part of Medicare covers physician…
Can providers charge different amounts…
This is known as the uniform billing f…
What is the insurance that covers depe…
Part B
No
CMS-1500
tricare
What part of Medicare covers physician…
Part B
Can providers charge different amounts…
No
26 terms
Ross Medical Insurance and Billing
ABN
primary carrier
secondary payer
physician fee schedule
is a waver the patients must sign if there is a possibility t…
is billed first and the most amount
is billed second and the lowest amount
amount charged for each procedure
ABN
is a waver the patients must sign if there is a possibility t…
primary carrier
is billed first and the most amount
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.
44 terms
Medical insurance billing chapter 10
Eligible for medicaid
Not eligible for medicaid
a physician who wishes to provide serv…
individuals enrolled in managed care p…
-legally blind & receive supplemental security income... -pregna…
-people who are eligible for TANF & receive financial assista…
Dept of human services
primary care provider
Eligible for medicaid
-legally blind & receive supplemental security income... -pregna…
Not eligible for medicaid
-people who are eligible for TANF & receive financial assista…
36 terms
Medical Insurance billing ch 9
Medicare Part A covers
The Original Medicare Plan requires a…
Determine which of the following indiv…
Which modifier indicates that a signed…
hospital services
coinsurance
a seventy-year-old man who has paid FICA taxes for twenty cal…
GA
Medicare Part A covers
hospital services
The Original Medicare Plan requires a…
coinsurance
26 terms
Medical Insurance Billing MMA ADMIN
EDI
Supporting claim documentation
Claim rejection
Medicare Part A
Another name for an electronic transmission
I.e operative notes, chart notes, laboratory reports
Several possibilities of why this could happen one being past…
Covers hospital care
EDI
Another name for an electronic transmission
Supporting claim documentation
I.e operative notes, chart notes, laboratory reports
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