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used to indicate what? Ans>> Reinstated or recycled code
qualifying circumstances? Ans>> Add-on codes
reported
on the CMS-1500 claim form before a further claim is required? Ans>> 12
and ICD codes for surgical procedures? Ans>> Operative report
Ans>> Verify the age of the account
Ans>> Block 24D contains the diagnosis code
Ans>> Gross Examination
Ans>> UB-04 Claim Form
Ans>> Red
Ans>> Patient
is the name of that health plan? Ans>> Medicaid
Ans>> Providers explain medical or diagnostic procedures, surgi- cal interventions, and the benefits and risks involved, giving patients an opportunity to ask questions before medical
intervention is provided.
Ans>> A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed.
Ans>> Agency that converts claims into standardized electronic for- mat, looks for errors, and formats them according to HIPAA and insurance standards.
Ans>> Documents that identify the person or provide enough information so that the person can be identified.
Ans>> Permission granted by the patient or the patient's representa- tive to release information for reasons other than treatment, payment, or health care operations.
Ans>> Payment for services rendered from a third-party payer.
Ans>> Review of claims for accuracy and completeness.
Ans>> Making false statements of representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
Ans>> Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.
Ans>> Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.
Ans>> Practices that directly or indirectly result in unnecessary costs to the Medicare program.
Ans>> Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity.
Ans>> Determines which insurance plan is primary and which is secondary.
Ans>> Medicare payment that is recovered after primary insur- ance pays.
Ans>> Claim submitted by people covered by a primary and sec- ondary insurance plan.
Ans>> Contract in which the provider directly bills the payer and accepts the allowable charge.
Ans>> The amount an insurer will accept as full payment, minus applicable cost sharing.
Ans>> Claim that is accurate and complete. They have all the information needed for processing, which is done in a timely fashion.
Ans>> Claim that is inaccurate, incomplete, or contains other errors.
Ans>> Processes Medicare Parts A and B claims from hospitals, physicians, and other providers.
Ans>> The report sent from the third-party payer to the provider that reflects any changes made to the original billing.
Ans>> Describes the services rendered, payment covered, and benefit limits and denials.
Ans>> Unique 10-digit code fro providers required by HIPAA.
Ans>> Plan that allows patients to only go to physicians, other health care professionals, or hospitals on a list of approved providers, except in an emergency.
Ans>> Additional information about types of services, and part of valid CPT or HCPCS codes.
Ans>> Voluntary supplemental medical insurance to help pay for physicians' and other medical professionals' services, medical services, and med- ical-surgical supplies not covered by Medicare Part A.
Ans>> Combined package of benefits under Medicare Parts A and B that may offer extra coverage for services such as vision, hearing, dental, health and wellness, or prescription drug coverage.
Ans>> A p.an run by private insurance companies and other vendors approved by Medicare.
Ans>> A private health insurance that pays for most of the charges not covered by Parts A and B.
Ans>> Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP)
Ans>> Written recommendation to a specialist.
Ans>> A review that looks at whether the procedure could be per- formed safely but less expensively in an out patient setting.
Ans>> A written request for a verification of benefits.
Ans>> Primary care physician
Ans>> Approval from the health plan for an inpatient hospital stay or surgery.
Ans>> A list of prescription drugs covered by an insurance plan.
Ans>> Providers and facilities in a PPO's network.
Ans>> Department that keeps track of what third-party payers the provider is waiting to hear from and what patients are due to make a payment.
Ans>> Measures the outstanding balances in each account.
Ans>> Information about health care services that patients have received and financial transactions that have taken place.
Ans>> Number that identifies specific episode of care, date of service, or patient.
Ans>> Number the provider uses to identify an individual patient's record.
Ans>> Document that outlines the amounts billed by the provider and what the patient must pay the provider.
Ans>> Purchaser of the insurance or the member of group for which an employer or association as purchased insurance.
Ans>> Unique code used to identify a subscriber's policy.
Ans>> The balance the policyholder must pay the provider.
Ans>> A group of submitted claims.
Ans>> Billing patients for charges in excess of the Medicare fee schedule.
Ans>> Notification by the physician to a patient that a service will not be paid.
Ans>> Form provided if a provider believes that a service may be declined because Medicare might consider it unnec- essary.
Ans>> Refers to the process the billing office goes through to determine what payments have come in from the third-party payer and what the patient owes the provider.
Ans>> Codes used to classify visits when circumstances other than disease or injury are the reason for the appointment.
Ans>> Codes used to classify environmental events, circumstances, and conditions, such as the cause of injury, poisoning, and other adverse events.
Ans>> A direct, professional meeting between a patient and a health care professional who is licensed to provide medical services.
Ans>> The incidence of death in a specific population.
Ans>> The number of cases of disease in a specific population.
Ans>> Code that covers physicians' services and hospital outpatient coding.
Ans>> Code designed to serve as supplemental tracking codes that can be used for performance measurement.
Ans>> Code used for temporary coding for new technology and services that have not met the requirements needed to be added to the main section of the CPT book.
Ans>> Six
Ans>> Form that includes information about past history, current history, inpatient record, discharge information and insurance information.
Ans>> The extraction of specific data from a medical record, often for use in an external database, such as a cancer registry.
