Study sets matching "medical coding and billing chapter 8"

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Study sets matching "medical coding and billing chapter 8"

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…
29 terms
medical billing & coding chapter 8 9
HCPCS is multilevel coding system that…
medicare and some state Medicaid syste…
Level II HCPCS codes are created by the
Level I HCPCS codes are created by the
2 levels
HCPCS level II
CMS
AMA
HCPCS is multilevel coding system that…
2 levels
medicare and some state Medicaid syste…
HCPCS level II
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…
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…
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
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
41 terms
Billing and Coding Chapter 8
PAC
SNF
LTCH
HHA
postacute care-provides patients with healthcare services for…
skilled nursing facility
long term care hospitals
home health agency
PAC
postacute care-provides patients with healthcare services for…
SNF
skilled nursing facility
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
english
billing codes
cpt codes
medical insurance
...
icd 10
cpt 9
health insurance today
english
...
billing codes
icd 10
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…
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
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…
49 terms
Chapter 8 Coding & Billing
CPT stands for:
The CPT manual often reflects the tech…
The CPT manual is ever changing and is…
What type of codes end with 99?
Current Procedural Terminology
Category 3 Codes
Revisions
Unlisted Procedures or Services
CPT stands for:
Current Procedural Terminology
The CPT manual often reflects the tech…
Category 3 Codes
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
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
8 terms
Medical Billing & Coding Chapter 8(Lesson 2 ICD-9)
Tabular List Volume 1
Alphabetic Index Volume 2
Procedures Volume 3
Non-essential modifiers are a
Confirm all outpatient codes in this volume, contains disease…
includes a table of drugs and chemicals, begin with this volu…
codes only used in the hospital setting, volume is not used i…
series of terms in parenthesis that may follow a main term. T…
Tabular List Volume 1
Confirm all outpatient codes in this volume, contains disease…
Alphabetic Index Volume 2
includes a table of drugs and chemicals, begin with this volu…
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
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.
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…
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
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.
79 terms
Medical Billing Chapter 8
8.1 HIPAA X12 837 Care Claim or Equiva…
8.2 CMS-1500
8.1 NUCC - National Uniform Claim Comm…
8.2 CMS-1500 (08/05)
Used to send a claim to primary and secondary payers... (based o…
paper claim for physician services
led by the AMA; determines the content of both HIPAA 837 and…
current paper claim approved by the NUCC
8.1 HIPAA X12 837 Care Claim or Equiva…
Used to send a claim to primary and secondary payers... (based o…
8.2 CMS-1500
paper claim for physician services
31 terms
Medical Terms for Billing and Coding
ablation
ABSTRACT
ABUSE
ACCESS
Ablation Erosive process is performed surgically to eliminate…
Is the collection of information from the medical record via…
A range of the following improper behaviors or billing practi…
Your ability to get needed medical care and services.
ablation
Ablation Erosive process is performed surgically to eliminate…
ABSTRACT
Is the collection of information from the medical record via…
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
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
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.
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…
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
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
91 terms
Medical Billing and Coding Chapters 11 - 13
TRICARE
Civilian Health and Medical Program of…
sponsor
Defense Enrollment Eligibility Reporti…
Government health program serving dependents of active-duty s…
replaced by TRICARE
uniformed service member in a family qualified for TRICARE or…
worldwide database of TRICARE and CHAMPVA beneficiaries
TRICARE
Government health program serving dependents of active-duty s…
Civilian Health and Medical Program of…
replaced by TRICARE
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
11 terms
Medical Billing and Coding Chap.1 (Prefix)
ab-
ad-
dys-
eu-
away from
toward or in direction of
bad, painful, difficult
good or normal
ab-
away from
ad-
toward or in direction of
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…
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 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…
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…
79 terms
Medical Billing Chapter 8
8.1 HIPAA X12 837 Care Claim or Equiva…
8.2 CMS-1500
8.1 NUCC - National Uniform Claim Comm…
8.2 CMS-1500 (08/05)
Used to send a claim to primary and secondary payers... (based o…
paper claim for physician services
led by the AMA; determines the content of both HIPAA 837 and…
current paper claim approved by the NUCC
8.1 HIPAA X12 837 Care Claim or Equiva…
Used to send a claim to primary and secondary payers... (based o…
8.2 CMS-1500
paper claim for physician services
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
51 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
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
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
108 terms
Medical Billing & Coding
-algia
-emia
-itis
-megaly
Pain
Blood condition
Inflammation
Enlargement
-algia
Pain
-emia
Blood condition
79 terms
Medical Billing Chapter 8
8.1 HIPAA X12 837 Care Claim or Equiva…
8.2 CMS-1500
8.1 NUCC - National Uniform Claim Comm…
8.2 CMS-1500 (08/05)
Used to send a claim to primary and secondary payers... (based…
paper claim for physician services
led by the AMA; determines the content of both HIPAA 837 and…
current paper claim approved by the NUCC
8.1 HIPAA X12 837 Care Claim or Equiva…
Used to send a claim to primary and secondary payers... (based…
8.2 CMS-1500
paper claim for physician services
Medical Billing Chapter 8
8.1 HIPAA X12 837 Care Claim or Equiva…
8.2 CMS-1500
8.1 NUCC - National Uniform Claim Comm…
8.2 CMS-1500 (08/05)
Used to send a claim to primary and secondary payers... (based o…
paper claim for physician services
led by the AMA; determines the content of both HIPAA 837 and…
current paper claim approved by the NUCC
8.1 HIPAA X12 837 Care Claim or Equiva…
Used to send a claim to primary and secondary payers... (based o…
8.2 CMS-1500
paper claim for physician services
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.
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…
107 terms
Terminology Billing/Coding Chapter 8
Aspirate
Acapnia
Anoxia
Aphonia
to draw foreign material into the lungs
Absence or decreased levels of carbon dioxide in the blood
Absence of lack of normal level of oxygen in the blood
Inability to produce sound or speech
Aspirate
to draw foreign material into the lungs
Acapnia
Absence or decreased levels of carbon dioxide in the blood
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