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Study sets matching "medical insurance billing and coding"

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Study sets matching "medical insurance billing and coding"

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
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…
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
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
...
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.
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…
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.
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…
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.
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…
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.
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…
15 terms
Medical Billing, Coding, and Insurance Chapter 3
What is the difference between a new p…
What is the difference between a parti…
What information does a patient inform…
What is an assignment of benefits?
A new patient is someone who has not received any services fr…
A participating provider is a provider who agrees to provide…
1. First name, middle initial, and last name... 2. Gender... 3. Rac…
Assignment of benefits is an authorization allowing benefits…
What is the difference between a new p…
A new patient is someone who has not received any services fr…
What is the difference between a parti…
A participating provider is a provider who agrees to provide…
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.
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…
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.
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…
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.
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.
59 terms
Chpt: 6 Medical Insurance, Billing and Coding
Allowed charge
Assignment of Benefits
Beneficiary
Birthday Rule
The maximum dollar amount an insurance carrier will cover for…
The patient authorizes the insurance carrier to pay the physi…
The beneficiaries are the subscriber and eligible person name…
Determines which insurance company is billed 1st (primary). T…
Allowed charge
The maximum dollar amount an insurance carrier will cover for…
Assignment of Benefits
The patient authorizes the insurance carrier to pay the physi…
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…
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…
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…
44 terms
Medical Insurance Billing and Coding Test 1
Who is responsible for third party rei…
Two different coding systems are?
Upcoding?
What is the fastest growing patient gr…
Insurance companies
1. Inpatient ... 2. Outpatient
Charging more than treatment costs
Elderly
Who is responsible for third party rei…
Insurance companies
Two different coding systems are?
1. Inpatient ... 2. Outpatient
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.
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…
Medical Insurance Billing/Coding Chapter 1&18
In a medical practice, front office du…
Generally, a high school diploma is no…
Working in a physician's office as an…
The medical profession has long subscr…
F
F
F
F
In a medical practice, front office du…
F
Generally, a high school diploma is no…
F
75 terms
Medical Billing & Coding Heald College: Chapter 3 | Basics of Health Insurance
Health Insurance
Implied Contract
Expressed Contract
Guarantor
A contract between the policy holder or member and the insura…
A contract between physician and patient not manifested by di…
A verbal or written agreement.
An individual who promises to pay the medical bill by signing…
Health Insurance
A contract between the policy holder or member and the insura…
Implied Contract
A contract between physician and patient not manifested by di…
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…
172 terms
Medical Coding and Insurance Billing Ch1-7 (2)
As blood enters the heart form the hea…
Break down the following words: Root w…
Break down the following words: Suffix…
Break down the following words: Word m…
Superior Vena Cava, (vena) cava; atrium, entricle; pulmonary;…
Isch; Lack of
Emia; Blood condition
lack of blood
As blood enters the heart form the hea…
Superior Vena Cava, (vena) cava; atrium, entricle; pulmonary;…
Break down the following words: Root w…
Isch; Lack of
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
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
39 terms
NCCT Insurance/coding Specialist- Medical Insurance & billing Procedures
1. In order to work competently as a m…
2. Information that must be included i…
3. Medical ethics will typically addre…
Everything that a medical claims speci…
b. to know procedural and diagnostic coding.
d. the state
d. Conduct
Confidential
1. In order to work competently as a m…
b. to know procedural and diagnostic coding.
2. Information that must be included i…
d. the state
27 terms
Medical Billing & Coding Heald College: Chapter 1 | Role of Insurance Billing Specialist
Cash Flow
Revenue
Cycle
Charge Entry
The amount of actual money available in a medical practice.
Income of a clinic or medical practice.
The period of time and steps dedicated to billing patients an…
The process of posting charges into the system for billing an…
Cash Flow
The amount of actual money available in a medical practice.
Revenue
Income of a clinic or medical practice.
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
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
75 terms
Medical Billing & Coding Heald College: Chapter 3 | Basics of Health Insurance
Health Insurance
Implied Contract
Expressed Contract
Guarantor
A contract between the policy holder or member and the insura…
A contract between physician and patient not manifested by di…
A verbal or written agreement.
An individual who promises to pay the medical bill by signing…
Health Insurance
A contract between the policy holder or member and the insura…
Implied Contract
A contract between physician and patient not manifested by di…
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
55 terms
Insurance Billing and Coding FINAL
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
3
Volume 3
What do the initials ICD stand for?
International Classification of DIseases
An ICD 9 & 10 code identifies what?
Diagnosis
172 terms
Medical Coding and Insurance Billing Ch1-7 (2)
As blood enters the heart form the hea…
Break down the following words: Root w…
Break down the following words: Suffix…
Break down the following words: Word m…
Superior Vena Cava, (vena) cava; atrium, entricle; pulmonary;…
Isch; Lack of
Emia; Blood condition
lack of blood
As blood enters the heart form the hea…
Superior Vena Cava, (vena) cava; atrium, entricle; pulmonary;…
Break down the following words: Root w…
Isch; Lack of
156 terms
Medical Coding and Insurance Billing Ch1-7 Flashcard
Define the root: Athero/o
Define the root: Granul/o
Define the root: Morph/o
Define the root: Thym/o
Vessel
Grain
Change Shape
Thymus Gland
Define the root: Athero/o
Vessel
Define the root: Granul/o
Grain
Medical Billing & Coding Heald College: Chapter 3 | Basics of Health Insurance
Health Insurance
Implied Contract
Expressed Contract
Guarantor
A contract between the policy holder or member and the insura…
A contract between physician and patient not manifested by di…
A verbal or written agreement.
An individual who promises to pay the medical bill by signing…
Health Insurance
A contract between the policy holder or member and the insura…
Implied Contract
A contract between physician and patient not manifested by di…
Insurance Coding and Billing
What do the initials ICD stand for?
An ICD 9 & 10 identifies what
How many ICD 9 volumes are there?
Which volume is used primarily in hosp…
International Classification of Diseases
Diagnosis
Three
Three
What do the initials ICD stand for?
International Classification of Diseases
An ICD 9 & 10 identifies what
Diagnosis
100 terms
Comprehensive Health Insurance: HCPCS and Coding, Auditing, Physician Medical Billing
Once a Medicare beneficiary signs the…
What modifier identifies an ABN on file?
If a chart note documents that the pat…
What is HPI?
Advance Beneficiary Notice (ABN)
HCPCS GA modifier
past history: the review of the patient's experiences with il…
History of Present illness: chronological description of the…
Once a Medicare beneficiary signs the…
Advance Beneficiary Notice (ABN)
What modifier identifies an ABN on file?
HCPCS GA modifier
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
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.
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
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…
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