insurance and billing

downcoding and upcoding are illegal practices and medical assistants can be prosecuted for either practice?

true

the international classification of diseases was established by?

world health organization

a list of the fixed fees for services is a?

fee schedule

an online marketplace where you can compare and buy individual health insurance plans

health insurance exchange

someone who is poor needy or impoverished considered?

indigent

services or supplies that are used to treat the patients diagnosis meet the accepted standard of medical practice?

medical necessity

services that are needed to improve that patients current health are considered?

medically necessary

when searching the alphabetic index, "humerus" is an example of which of the following?

organ or anatomical site

a written agreement between two parties in which one party agrees to pay another party if certain specified circumstances occur?

policy

an abnormal condition resulting from a previous disease describes which of the following terms?

sequela

burns are coded by?

site and degree & the body surface involved

a document sent by the insurance company to the provider and the patient explaining the allowed charge the amount reimbursed and the patients financial responsibilities is?

EOB ( explanation of benefits)

a system used to determine how much providers should be paid for services rendered?

RBRVS (resource based related value scale)

to settle or determine with a court of law?

adjudicate

when performing diagnostic coding you should start by looking in the?

alphabetic index

a designated person who receives funds from a insurance policy?

beneficiary

a payment arrangement for healthcare providers in which the provider is paid a set amount whether the patient receives services or not?

capitation

a formal request for payment from a insurance company for services provided?

claim

ICD-10 uses up to _____ characters to identify a disease or injury

7

the identifier assigned to healthcare providers by license and medical specialties ?

NFI

the abbreviation that is the equivalent of "unspecified" is?

NOS