What do the initials ICD stand for?
When treating a minor in a family practice clinic how long must you keep their medical records based their legal age according to the statute of limitations?
(18+3=21)
How many digits does the CPT code consist of?
5
Who is eligible for Medicare?
65+, Disabled, End Staged Renal Disease, ALS
Policyholder
A person who owns the insurance policy
Deductible
A specified amount of money that the insured must pay before an insurance company will pay a claim
What are the eligibility requirements for workers compensation?
All employees that are injured on the job or develop a work related illness while performing their job duties
Copay
Amount that patients who are covered by insurance must pay themselves for health care services
What is assignment of benefits mean?
Arrangement by which a patient requests that the payment be made directly to the provider.
What is the name of the third party reimbursement universal claim form that is used by most physicians and facilities?
CMS-1500
Wha codes are used with modifiers?
CPT
What does CMS stand for?
Centers for Medicare and Medicaid Services
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 do the initials CPT stand for?
Current Procedural Terminology
An ICD-10 code identifies what?
Diagnosis
Describe what medi/medic insurance coverage is
Dual eligible coverage. Medicare is billed first as primary insurance and Medicaid is billed as the secondary insurance
An office visit code is also known as a CPT code that can be found in what section of the CPT manual?
Evaluation and Management
What does E & M stand for?
Evaluation and Management
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
Medicare is sponsored by whom?
Federal government
Indemnity plans are also known as a traditional plan and what other name?
Fee-for-service
Allowable charge
Fees Medicare and other third party payers allow for a particular service or supply
Advance beneficiary notice
Form that Medicare requires all healthcare providers to use when Medicare does not pay for a services. Patients must sign the form to acknowledge that they understand they have a choice about their healthcare procedure or service in the event that Medicare does not pay.
What does HMO stand for?
Health Maintenance Organization
What is the birthday rule?
Helps to determine which health plan is considered primary, when individuals (usually children) are listed as dependents on more than one health plan
Which coding system is used in an ambulatory care setting?
ICD-10-CM
The ICD-10 coding system consists of two parts. Name the two parts.
ICD-10-CM and the ICD-10-PCS
Which coding system is used primarily in hospitals?
ICD-10-PCS
Flexible spending account (FSA)
IRS section 125 cafeteria plan. Cost of the plan premium is deducted from the employees wages before withholding taxes are deducted, allowing employees the option of pretax payroll deduction for some insurance premiums, unreimbursed medical expenses, and child or dependent care expenses
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
What are the names of the two basic health insurance Plans?
Indemnity and managed care
Mandatory benefits that states must provide in order to receive federally matching funds for Medicaid programs?
Inpatient hospital services, outpatient hospital services, home health services, physician services, nursing facility services, early and periodic screening, diagnostic and treatment services and rural health clinic services.
Define workers compensation
Insurance regulated by state laws that pay medical expenses and partial loss of wages for employees who are injured on the job or become ill as a result of work related circumstances
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
The first character of an ICD-10 code is what?
Letter
Name the four benefits covered under workers compensation
Medical expenses, disability pay, vocational rehabilitation, and death benefits
Medicare Part B covers
Medical insurance
Medicare part C
Medicare advantage plan
What is modifier -99 used for?
Multiple modifiers are required to further explain unusual circumstances
Premiums
Period fee that a fee for service policy holder must pay to the insurance company in exchange for financial protection against loss
What is a third party administrator?
Person or organization who processes claims and performs other contractual administrative services
The "x" in the ICD-10 manual is used for what purpose?
Placeholder
Medicare part D
Prescription drug coverage
A CPT code identifies what?
Procedures
Who is eligible for Medicaid?
Residents of the United States, SSI recipients, families, pregnant women, children, the blind, aged and disabled individuals
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
Medicaid is sponsored by whom
State and federal governments
Who is tricare managed by?
The defense health agency
CHAMPVA is insurance coverage for whom and is oversee by whom?
Veterans and is overseen by the veterans administration in Denver,co
In the ICD-10 Z-codes are used for what purpose?
Z-codes purpose is circumstances other than disease, injury, or external cause that are recorded as "diagnoses" or "problems"
Medicare Part A covers
hospital services