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Medical Billing Basics Flashcards

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10924186041chargemaster (charge description master [CDM])document that contains a computer-generated list of procedures, services, and supplies with charges for each.0
10924199982Billing ProceduresComputer-generated statements. Encounter forms. Photocopied statements. Online billing statements1
10924615362What Items do chargemasters generally contain?CPT/HCPCS *Procedure* Code Charge *Description* *Revenue* Code Charge *Department* Code *Charge* Code Charge *Status*2
10924615363Charge description master (CDM) or Chargemasteris a large database that contains the price list for all services provided to its patients. Also used to collect information on all the goods and services provided to patients.3
10924615364CDMCharge Description Master4
10926984189HCPCSHealthcare *Common* Procedure Coding System ("hick picks")5
10927010528CPT*Current* Procedural Terminology6
10927426541All chargemasters contain which item(s)? Dprocedure code description charge all of the above7
10927447265The healthcare provider's comprehensive price list of all supplies, services, and equipment usage fees is referred to as the chargemaster or ___C__.procedure codes provider schedule CDM master list8
10927461314The fees on the chargemaster __B___.are always the same vary from provider to provider are set by the procedure code system do not include tax9
10927480382How often is the chargemaster or fee schedule updated? Bevery day every year (at a minimum) every five years (at a minimum) never10
10927570385The CDM, may also be calledthe service master price list charge list service item master,11
10966144715chargemaster committeeHIM Finance, & billing Technical and informations systems Management from all clinical departments12
10966152130plan for CDM Maintenance.*Purpose* - Compliance *Frequency* - Update CDM & Codes, *Risks*- minimize violations *Process* - Line by line review of codes and charges *Responsible Parties* - Chargemaster committee13
10974051653Charge DescriptionThe charge or *item* description identifies the procedure, service, product (including medications), or other items provided to a patient.14
10974093706Elements of a chargemaster*Descriptions* : Charge Description *Codes*: Procedure, Service, or Product code, Revenue Code, Department code, Charge Code *Charges*: Charge, Charge Status15
10974161362Procedure, Service, or Product codeCPT or HCPCS Level II codes *identify the specific* procedure, service or product supplied to the patient16
10974175947Revenue codeUnique 4-digit number that represent descriptions and dollar amounts charged for hospital services provided to a patient.17
10974188029Department codeidentifies the department that revenue should be allocated to for*accounting purposes*.18
10974211387Charge codeEach item in the chargemaster is *uniquely identified* by a charge code *assigned by the organization* and may also be referred to as the *charge description number* or *item code*19
10974242730chargesimply the price or fee charged for the item.20
10974251054charge statusindicates *active assignment* of a charge and can be used for *tracking* when and how often an item has been charged.21
15764575831Hard codingUse of the charge description master to code repetitive services.22
15764587624soft codingCoders perform the coding on procedures that vary from patient to patient.23
15765367570Process for Coding/Billing for Healthcare Services Physicians and nonDiagnosis Codes - ICD-10-CM Procedure Codes - CPT® Supply Codes - HCPCS (if applicable) Billing - CMS-1500 form24
15765471275Coding/Billing for Outpatient Healthcare InstitutionsDiagnosis Codes - ICD-10-CM Procedure Codes - CPT® (billing) Supply Codes - HCPCS (as appropriate) Billing - UB-04 form25
15765527688What procedure systems are used for outpatient hospital settings?procedures are reported with CPT® and HCPCS codes in all outpatient hospital settings.26
15765560732What procedure system is used to report inpatient billing?The new procedure system ICD-10-PCS is for hospital inpatient billing27
15765629657The Medicare ExceptionMedicare requires all charges for same-day surgery to be billed on the CMS-1500. Coding/Billing for Medicare Patients for Outpatient Surgery Diagnosis Codes - ICD-10 Procedure Codes - CPT® (billing) Supply Codes - HCPCS (as appropriate) Billing - CMS-150028
15784783335What are the four main parts to a superbill?Provider information - includes name, degree, service location, and signature. Patient information - patient's name, DOB, and insurance information. Service information - date of service, CPT and ICD-10-CM codes, modifiers, time, units, quantity for drugs, and authorization information. Additional information - notes and comments.29
15785264651Coding and Billing by Service Provider30
15784828719Who Uses the UB-04?Facilities31
15784844488Where are revenue codes required?UB-04 for facilites32
15784885236What are the components for a Revenue code?1) demographics, including payer information 2)fee for each service from the chargemaster 3)charge list, with description 4)correct diagnosis, procedure, and supply codes33
15784988343Who uses CMS 1500 and what is billed?Physician's offices. Professional services and equipment and supply charges34

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