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Study sets matching "school medical billing"

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Study sets matching "school medical billing"

68 terms
medical billing
`Reimbursement specialist
The document submitted to the payer re…
The center for medicare and medicaid s…
A healthcare practitioner is also call…
an other name for health insurance specialist
Health insurance claim.
Department of health and human services
provider
`Reimbursement specialist
an other name for health insurance specialist
The document submitted to the payer re…
Health insurance claim.
38 terms
Medical Billing
Accept assignment
Accounts receivable
Accounts receivable aging report
Allowed charges
Provider accepts as payment in full whatever is paid on the c…
The amount owed to a business for services or goods provided
Shows the status of outstanding claims from each payer, as we…
The maximum amount the payer will reimburse for each procedur…
Accept assignment
Provider accepts as payment in full whatever is paid on the c…
Accounts receivable
The amount owed to a business for services or goods provided
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
21 terms
Medical Billing
Out of pocket
Schedule of benefits
Third party payer
Pre authorization
Expenses the insured must pay before benefits begin.
List of medical expenses that a health plan covers
Private or government organization that insures or pays for h…
Prior authorization from a payer for a service to be provided.
Out of pocket
Expenses the insured must pay before benefits begin.
Schedule of benefits
List of medical expenses that a health plan covers
41 terms
Medical billing part 2
Abuse
Authorization
Breach of confidentiality
Case law
Actions inconsistent with accepted, sound medical, business o…
Document that provides official instruction, such as the cust…
Unauthorized release of patient information to a third party
Also called common law: based on a court decision that establ…
Abuse
Actions inconsistent with accepted, sound medical, business o…
Authorization
Document that provides official instruction, such as the cust…
26 terms
Medical billing part 3
American Academy of Professional Coder…
American Health Information Management…
American Medical Billing Association (…
Centers for Medicare and Medicaid Serv…
Professional association established to provide a national ce…
Founded in 1928 to improve the quality of medical records and…
Offers the Certified Medical Reimbursement Specialists (CMRS)…
Formerly known as the Health Care Financing Administration (H…
American Academy of Professional Coder…
Professional association established to provide a national ce…
American Health Information Management…
Founded in 1928 to improve the quality of medical records and…
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
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
10 terms
Medical Billing
direct provider
assignment of benefits
new patient
secondary insurance
the provider who treats the patient
authorization by a policyholder that allows a payer to pay be…
a patient who has not received professional services from a p…
the insurance plan that pays benefits after payment by the pr…
direct provider
the provider who treats the patient
assignment of benefits
authorization by a policyholder that allows a payer to pay be…
13 terms
Medical Billing
CCT Requirements
EKG Documentation
Splinting and Strapping Documentation
X-Ray Interpretation
1. Critically ill or injured patient... 2. Physician interventio…
1. Rate & Rhythm... 2. Any 3 additional elements: axis, ST segme…
1. Location of Splint... 2. Type of Splint... 3. Applied by... 4. Reas…
1. Type... 2. Number of Views... 3. 3 positive or negative findings…
CCT Requirements
1. Critically ill or injured patient... 2. Physician interventio…
EKG Documentation
1. Rate & Rhythm... 2. Any 3 additional elements: axis, ST segme…
14 terms
Intro to Medical Billing
account aging
balance due
bankruptcy
claim message
The process of finding out how long specific account balances…
Total amount owed.
Legal process by which the debts of an individual or business…
Messages encouraging payment of a bill, usually attached to o…
account aging
The process of finding out how long specific account balances…
balance due
Total amount owed.
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
12 terms
Medical Billing/Quiz 2
what is the name of the form used to s…
which federal agency is responsible fo…
this form is required by a medical bil…
this type of coverage is provided for…
cms-1500 form
medicare
superbill
medicare part a
what is the name of the form used to s…
cms-1500 form
which federal agency is responsible fo…
medicare
69 terms
Medical Billing Ch. 15 Patient Billing and Collections
Patient billing and collections, last…
Patient Financial Responsibility - def…
Policies should handle:
Effective patient billing includes:
- Generating and mailing patient statements showing patient b…
- financial arrangements & payment plans... - payments not cove…
- collection of copayments, deductibles & past-due balances…
educating patinets from the start of the billing & reimbursem…
Patient billing and collections, last…
- Generating and mailing patient statements showing patient b…
Patient Financial Responsibility - def…
- financial arrangements & payment plans... - payments not cove…
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
100 terms
Medical billing
Coordination of benefits (COB)
Provider's signature
Optionally Renewable
Signature on file
When a patient has more than one insurance policy, this claus…
A_______ on a CMS-1500 claim form is acceptable as handwritte…
A provision that allows the policyholder the right to refuse…
SOF
Coordination of benefits (COB)
When a patient has more than one insurance policy, this claus…
Provider's signature
A_______ on a CMS-1500 claim form is acceptable as handwritte…
10 terms
Medical and billing
Physician Services
hospital services/facility billing
Two Major Types Of Medical Billing
(Can be referred to as inpatient servi…
Also called professional services or doctor services. What ty…
Inpatient billing. Also called facility billing. there has to…
Physician Services. Also called Professional Services
Acute care is a branch of secondary health care where a patie…
Physician Services
Also called professional services or doctor services. What ty…
hospital services/facility billing
Inpatient billing. Also called facility billing. there has to…
19 terms
Medical Billing
Overpayment
Truth in lending statement
Underpayment
Accounts payable
Funds a provider or beneficiary has received in excess of amo…
Covers credit agreements that involve more than 4 payments
When a medical claim is submitted for a simple procedure, but…
Money owed by a business; the practice's expenses.
Overpayment
Funds a provider or beneficiary has received in excess of amo…
Truth in lending statement
Covers credit agreements that involve more than 4 payments
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
20 terms
Medical billing
ICD-10-CM codes are alphanumeric, with…
ICD-10-CM codes have a maximum of five…
The letter N is assigned as a fifth ch…
There are 10 times more codes in the I…
False
False
False
False
ICD-10-CM codes are alphanumeric, with…
False
ICD-10-CM codes have a maximum of five…
False
15 terms
Medical billing
If there are separate codes for both t…
I-10 presumes a cause-and-effect relat…
Septic shock does not indicate the pre…
A code from category G89 (Pain) should…
False
True
False
True
If there are separate codes for both t…
False
I-10 presumes a cause-and-effect relat…
True
21 terms
Medical billing
Chem
Cry/o
Melan
Myc/o
Drug
Cold
Black
Fungus
Chem
Drug
Cry/o
Cold
21 terms
Medical Billing
Canada Health Act
Health Insurance Act
RRO 1990, Reg 552 (Health Insurance Act)
Independent Health Facilities Act
Establishes health care standards in Canada... Determines transf…
Provides structure for health insurance... MOHLTC - Ministry of…
Provides rules, guidelines, and process for applying the Heal…
Provides the requirements for funding, licensing, and standar…
Canada Health Act
Establishes health care standards in Canada... Determines transf…
Health Insurance Act
Provides structure for health insurance... MOHLTC - Ministry of…
29 terms
Medical billing
Chapter 11, Diseases of the Digestive…
For certain conditions, the bone may b…
Staphylococcus aureus arthritis of the…
For hemorrhage to be reported, there d…
True
False
False
True
Chapter 11, Diseases of the Digestive…
True
For certain conditions, the bone may b…
False
29 terms
Medical billing
00100
15300
16100
17100
Office visit 2 to 49
50 to 59
60 to 69
70 and up
00100
Office visit 2 to 49
15300
50 to 59
10 terms
Chapter 13: Medicare Medical Billing and Chapter 14: Medicaid Medical Billing
Benefit Period
Categorically Needy
Crossover
Intermediaries
A period of time during which medical benefits are available…
The Medicaid eligibility group that includes cash recipients…
Reassignment of gaps in coverage that eliminates the need for…
A private company that has a contract with Medicare to pay Pa…
Benefit Period
A period of time during which medical benefits are available…
Categorically Needy
The Medicaid eligibility group that includes cash recipients…
204 terms
Medical Billing
1. Administrative medical office respo…
2. A claims assistant professional
3. The amount of money an insurance bi…
4. A billing specialist is entrusted w…
Claims submissions
Works for the consumer and helps patients file insurance claims
Knowledge,experience, and size of employing institution
Holding patient's medical information in confidence, collecti…
1. Administrative medical office respo…
Claims submissions
2. A claims assistant professional
Works for the consumer and helps patients file insurance claims
92 terms
Medical Billing
LIP/O
SARC
OMA
MELAN
Fat
Flesh
Tumor
Black
LIP/O
Fat
SARC
Flesh
18 terms
Medical Billing
Critical care is coded
Key component in coding medical decisi…
Physician counseling is considered key…
Physician telephone calls are usually
Ventilator management included
Level of complexity
Counseling exceeds 50% of time spent
Not paid by third party payers
Critical care is coded
Ventilator management included
Key component in coding medical decisi…
Level of complexity
20 terms
Medical billing
Outpatient coding
Over view of Icd9
Using Icd 9
Chapter specific guidelines
Chapter 9
Chapter8
Chapter 10
Chapter11
Outpatient coding
Chapter 9
Over view of Icd9
Chapter8
45 terms
medical billing
Adjudication
Admitting physician
Allowed amount
Ambulatory Payment Classification System
The insurance carrier's process of evaluating a claim for pay…
The doctor responsible for admitting a patient to a hospital
Maximum amount an insurance payer considers reasonable for me…
Prospective payment system used for outpatient services with…
Adjudication
The insurance carrier's process of evaluating a claim for pay…
Admitting physician
The doctor responsible for admitting a patient to a hospital
8 terms
medical billing
insurance claims forms
more on cms 1500
usually completed using a computer pro…
electronic claims submitted to a clear…
most common claim form used in the medical office is the cms…
updated in 2005 to accept npi number (national provider ident…
...
insurance logs still need to be kept for submission of each p…
insurance claims forms
most common claim form used in the medical office is the cms…
more on cms 1500
updated in 2005 to accept npi number (national provider ident…
77 terms
Medical billing
Sugar
Fat
Stomach
Joint
Glycos/o
Apid/o
Gastr/o
Arthr/o
Sugar
Glycos/o
Fat
Apid/o
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…
26 terms
Medical billing
Cpt
Who use cpt
Icd-10
Who use icd-10-cm
Current procedural terminology
Will be used by all health care providers for outpatient proc…
International classification of diseases
Will be used for all inpatient and outpatient diagnosis
Cpt
Current procedural terminology
Who use cpt
Will be used by all health care providers for outpatient proc…
25 terms
Medical Billing Test
NPI
CMS-1500
Timely filing
CCI edits
unique ten digit identifier assigned to each provider by the…
paper claim for physician services
Medicare requires claim to be filed no later than within one…
apply to Medicare claims that bill for more than one procedur…
NPI
unique ten digit identifier assigned to each provider by the…
CMS-1500
paper claim for physician services
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…
8 terms
Medical billing
HIPAA
OIG
GEMs
CMS
Health insurance portability and acountability act
Office of the inspector general
General equivalence mappings
Centers for Medicare and Medicaid services
HIPAA
Health insurance portability and acountability act
OIG
Office of the inspector general
10 terms
Medical Billing
Arrival:
Assignment of Benefits:
Center For Medicare & Medicaid Service…
Certified Coding Specialist (CCS):
Terms used to describe a patient who has appeared for his/her…
A patient's insurance claim benefits are sent directly from t…
Agency of the federal government responsible for Administrati…
A coding certification awarded by the American Health Informa…
Arrival:
Terms used to describe a patient who has appeared for his/her…
Assignment of Benefits:
A patient's insurance claim benefits are sent directly from t…
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…
25 terms
Medical Billing Medical Abbreviations
O
OD
OS
OU
orally
right eye
left eye
both eyes
O
orally
OD
right eye
33 terms
Medical Billing
What is Health care?
What does Medical care include?
What is Liability Insurance?
What is a (TPA) third party administra…
medical care that includes preventative services.
Includes the identification of disease and the Provisional ca…
A policy that covers losses to a third party caused by the in…
administer health care plans and process claims.
What is Health care?
medical care that includes preventative services.
What does Medical care include?
Includes the identification of disease and the Provisional ca…
37 terms
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
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…
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
86 terms
Medical Coding & Billing
Skin
Epidermis
Stratum germinativum
Stratum spinosum
Primary Function/Description... Protection, regulation, sensatio…
Outer protective covering of the body that can be divided int…
Innermost epidermal layer responsible for regeneration of the…
Means "spiny layer." Each time a stem cell divides one of the…
Skin
Primary Function/Description... Protection, regulation, sensatio…
Epidermis
Outer protective covering of the body that can be divided int…
20 terms
medical and billing
assignment of benefits
capitation rate
clean claim
denied claim
written authorization giving the insurance company the right…
A fixed payment that a patient makes to a health insurance co…
medical claim filed with a health insurance company that is f…
A claim processed by the payer resulting in a determination t…
assignment of benefits
written authorization giving the insurance company the right…
capitation rate
A fixed payment that a patient makes to a health insurance co…
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…
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
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