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Medical Billing Theory Final Review Flashcards

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1082895148How many types of release forms are there?there are three: medical, telephone, HIV/AIDS0
1082895149Encounter Form/Superbillform used by the physician to select frequently used CPT-4 & ICD-91
1082895150Copaymentsmall fee paid upon every office visit2
1082895151Demographicsterm used to identify all pt info. necessary for all forms3
1082895152Insuredone who has or is given insurance4
1082895153Exclusionprocedures not covered by insurance5
1082895154Deductibleamt paid by the patient to the insurance policy before the plan begins to pay6
1082895155ICD-9international classification of diseases ninth edition7
1082895156CPT-4current procedural terminology fourth edition8
1082895157HCFA-1500old form used to bill for services rendered9
1082895158CMS-1500current form used for billing services re10
1082907585Picks up where primary insurance left offsecondary insurance11
1082907586picks up where secondary insurance left offtertiary insurance12
1082907587MCRmedicare13
1082907588MCDmedicaid14
1082907589SOFsignature on file15
1082918491TRICAREis aka CHAMPUS16
1082918492CHAMPVAfederal health benefit that covers veterans and their families17
1082918493Workers &Compensationgiven to an employee who is injured on the job, and is has their employer responsible for their medical expenses18
1082918494Insureraka carrier, ins. carrier, insurance company19
1082918495self payis the status of a patient that has no ins. coverage and must pay out-of-pocket20
1082924939re-submissionthe process of resending a previous dirty claim and made the necessary corrections for payment21
1082924940birthday rulethe technique used to determine a dependents primary and secondary ins. when they have two parents with ins. polocies.22
1082934688A listing of physician feesFee Schedule23
1082934689pre-existing conditioncondition that exists prior to a new ins. policy24
1082934690EOBexplanation of benefits, a letter given to doctor and patient which has the charges, allowed amt for services rendered.25
1082934691clean claimclaim with no errors, omissions, fraudulent information.26
1082934692dirty claimclaim with errors, omissions, fraudulent information.27
1083013508Medicare Part Acovers hospital expenses28
1083013509Medicare Part Bcovers medical visits29
1083013510Medicare Part Dcovers prescriptions30
108301351199204example of a CPT-4 code31
1083013512401.9example of a ICD-9 code32
1083236704O.V.office visit33
1083236705T.O.S.type of service34
1083236706P.O.S.place of service35
1083236707HMOhealth maintenance organization36
1083236708PPOpreferred provider organization37
1083236709N.F.no fault38
1083236710any changes performed on a patients accountadjustment39
108323671130-90 daysclaims submission time40
1083236712L.E.life expectancy41
1083236713Hospital benefitmedical coverage for a hospital stay42
1083236714inpt.in patient (patient is staying over night in the hospital)43
1083236715est. pt.a patient that has been seen at least once44
1083236716N.P. or initialmeans new patient (never been seen before)45
1121677307P.F.problem focused, Level I46
1121677308E.F.expanded focused, Level II47
1121677309Lowroutine, 20-30 mins48
1121677310Moderate30-45 mins49
1121677311High45-1 hour or more50
1121677312Form given to obtain information regarding pts CC in a specialties officeQuestionnaire51
1121677313Form used to document all CC, vitals, and etcProgress Notes (3rd form)52
1121677314Form that has all patient historyHistory Form (2nd form)53
1121677315Social Hxsex, smoking, drugs, alcohol, other activities54
1121677316Work Hxjob activities or exposures55
1121677317Medical Hxhas information from all medical issues from birth to present day56
1121677318Family Hxmedical history regarding your family blood line57
1121720250F/Ufollow up58
1121720251E/Mevaluation and management first section of the CPT-459
1121720252Indexlocated in the back of the CPT-4 book60
1121720253Anesthesiasecond section of the CPT-4 book, where codes are found for anesthesia, numbing agents61
1121720254Surgerylargest section in the CPT-4 book and lists procedures regarding all 12 body systemt62
1121720255Radiologysection of the CPT book that refers to nuclear medicine, sonography procedure codes63
1121720256Pathology & Laboratorysection of the CPT book that has codes regarding laboratory or pathology such as: urinalysis and hematology64
1121720257CPT-4 Book hasSix sections excluding the index65
1121720258ICD-9 Book hasthree volumes I, II, III66
1121720259Modifiersare two digit codes that attach to CPT-4 codes to express specificity67
1121725794UB-04 formused to bill for hospital claims68
1121725795Encounter form used in the hospitalCharge Master69
1121725796Consultationis an examination with a specialist70
1121725797In patientmeans overnight stay at a hospital71
1121725798Out patienthaving an exam or test in a hospital and able to return home afterwards72
1131169623MCR covers__________ of a claim80%73
1131169624MCD usually is the ___________ ins, alongside MCRsupplemental74
1131169625_________has six sections excluding the indexCPT-4 Book75
1131169626_________ has 3 volumesICD-9 Book76
1131169627Volume II has____________the Tabular list which is used to verify ICD-9 codes77
1131169628HCPCS codesare used in hospital billing78
1131169629Volume I has ______________the alphabetic index of the ICD-9 book79
1131185829The largest section in the CPT-4 bookSurgery due to the 12 body systems80
1131185830The last section of the CPT-4 bookindex, located in the back of the book81
1131185831The third section in the CPT-4 bookSurgery82
1131185832The section in the CPT-4 book where codes begin with two zerosAnesthesia83
1131185833The section in the CPT-4 book where codes begin with the digit sevenRadiology84
1131185834The section in the CPT-4 book where codes begin with the digit eightLaboratory & Pathology85
1131185835The section in the CPT-4 book where codes begin with the digit nineMedicine86
1801816381UB-92old claim form used for hospital claims87
1801816382UB-04new claim form for hospital claims88
1801816383MCOensures insurance affordability89
1801881971Medicare PART Cpart of advantage care plan90

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