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
