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Pima Insurance Coding Billing Final Exam
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What does ICD stand for? - ✔✔International Classification of Disease An ICD-10 code identifies what? - ✔✔Diagnosis The ICD-10 coding system consists of what two parts? - ✔✔ICD- 10 - CM, IVD- 10 - PCS Which coding system is used primarily in hospitals? - ✔✔ICD- 10 - PCS Which coding system is used in an ambulatory care setting? - ✔✔ICD- 10 - CM The "X" in the ICD-10 manual is used for what purpose? - ✔✔Placeholder The first character of an ICD-10 code is what? - ✔✔A letter (True or False) An ICD-10 code contains 3-7 characters maximum? - ✔✔True When Facilitating payment from the insurance company to the medical office a standard coding system is used to report the patients reason for seeing the doctor and for any services/procedures for supplies that are done. What are the three types of codes that would be used in place of the reason for seeing the doctor as well as the service/procedure or supplies that was received? - ✔✔ICD-10, CPT, HCPCS What is the name of the third-party reimbursement universal claim form that is used by most physicians and facilities? - ✔✔CMS- 1500
In the ICD-10, Z-codes used for what purpose? - ✔✔Z-codes purpose is circumstances other than disease, injury, or external cause that are recorded as "diagnoses" or "problems" What do the initials CPT stand for? - ✔✔Current Procedural Terminology A CPT code identifies what? - ✔✔Procedures How many digits does the CPT consist of? - ✔✔ 5 What does E/M stand for? - ✔✔Evaluation and Management An office visit code it is also known as a CPT code that can be found in what section of the CPT manual? - ✔✔Evaluation and Management What codes are used with modifiers? - ✔✔CPT codes What is modifier - 99 it used for? - ✔✔Multiple modifiers are required to further explain unusual circumstances Who is eligible for Medicare? - ✔✔Individuals that are 65 years of age or older, the blind, disabled individuals younger than 65, and individuals with end-stage renal disease Explain the different parts of Medicare: - ✔✔A) Medicare Part A - Hospital Insurance B) Medicare Part B - Medical Insurance C) Medicare Part C - Medicare Advantage Plan D) Medicare Part D - Medicare Prescription Drug Program Medicare is sponsored by whom? - ✔✔Federal Government
Define Flexible Spending Account (FSA): - ✔✔Type of Section 125 plan. The cost of the plan premium is deducted from the employees wages before withholding taxes are deducted, allowing employees to use pretax dollars to pay for out-of-pocket health and dependent-care expenses. Define Health/Medical Savings Account (HSA/MSA): - ✔✔Special tax shelter that works in conjunction with a low-cost, high-deductible health insurance policy to provide comprehensive healthcare coverage at the lowest possible net cost for individuals who qualify. HSA/MSA are set up for the purpose of paying medical bills, allowing individuals to make tax-deferred contributions to personal retirement funds. What are the names of two basic health insurance plans? - ✔✔Indemnity and managed care What does HMO stand for? - ✔✔Health Management Organization What is an EOB? - ✔✔Explanation of Benefits. A document prepared by the insurance carrier that provide details of how the claim was adjudicated or paid out. What is a third-party administrator? - ✔✔Person or organization who processes claims and performs other contractual administrative services. Indemnity plans are also known as traditional plans, and what other name? - ✔✔Fee-for-Service What does COBRA stand for and what is its purpose? - ✔✔Consolidated Omnibus Budget Reconciliation Act. Provides workers who lose their health insurance benefits and their dependents the right to continue group coverage temporarily under the same group health plan sponsored by their employer in certain instances where coverage under the plan would otherwise end. What is coordination of benefits mean (COB)? - ✔✔When a patient and spouse (or parent) are covered under two separate employer group policies, the total benefits an insured can receive from both group plans are limited to no more than 100% of the allowable expenses, preventing the policyholder(s) from making a profit on health insurance claims. The primary plan pays benefits up to its limit, and secondary plan pays the difference, up to its limit)
What is assignment of benefits mean? - ✔✔Arrangement by which a patient requests that the payment be made directly to the provider What is the Birthday Rule? - ✔✔Helps to determine which health plan is considered a primary, when individuals (usually children) are listed as dependents on more than one health plan When treating a minor and a family practice clinic how long must you keep their medical records based on their legal age according to the statute of limitations? - ✔✔18+3= What must be done first before submitting the CMS-1500 form for insurance reimbursement? - ✔✔It must be completely filled out and proofread before it is submitted to an insurance carrier What does CMS stand for? - ✔✔Centers for Medicare and Medicaid Services Claims are denied for the following reasons: - ✔✔Incomplete/invalid diagnostic codes, charges not itemized, providers signature missing, member ineligible, benefit not covered, benefit maximum has been met, missing or incorrect modifiers, and omitted or inaccurate provider information or NPI Define Premiums - ✔✔Basic fees collected by the insurer on monthly/annual basis Define co-pay - ✔✔A specific amount of money a patient pays for a particular service Define Advance Beneficiary Notice (ABN) - ✔✔Also known as a waiver of liability, it is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service. Define Policyholder - ✔✔one who purchases the contract Define deductible - ✔✔a specified amount of money that the insured must pay each year before an insurance company will pay a claim
