Medical Billing Theory Final Review Flashcards

HIGHLIGHTED WORDS OR FAVORITES WILL NOT APPEAR ON TEST #2 EXAMINATION ;-)

1082895148	How many types of release forms are there?	there are three: medical, telephone, HIV/AIDS	0
1082895149	Encounter Form/Superbill	form used by the physician to select frequently used CPT-4 & ICD-9	1
1082895150	Copayment	small fee paid upon every office visit	2
1082895151	Demographics	term used to identify all pt info. necessary for all forms	3
1082895152	Insured	one who has or is given insurance	4
1082895153	Exclusion	procedures not covered by insurance	5
1082895154	Deductible	amt paid by the patient to the insurance policy before the plan begins to pay	6
1082895155	ICD-9	international classification of diseases ninth edition	7
1082895156	CPT-4	current procedural terminology fourth edition	8
1082895157	HCFA-1500	old form used to bill for services rendered	9
1082895158	CMS-1500	current form used for billing services re	10
1082907585	Picks up where primary insurance left off	secondary insurance	11
1082907586	picks up where secondary insurance left off	tertiary insurance	12
1082907587	MCR	medicare	13
1082907588	MCD	medicaid	14
1082907589	SOF	signature on file	15
1082918491	TRICARE	is aka CHAMPUS	16
1082918492	CHAMPVA	federal health benefit that covers veterans and their families	17
1082918493	Workers &Compensation	given to an employee who is injured on the job, and is has their employer responsible for their medical expenses	18
1082918494	Insurer	aka carrier, ins. carrier, insurance company	19
1082918495	self pay	is the status of a patient that has no ins. coverage and must pay out-of-pocket	20
1082924939	re-submission	the process of resending a previous dirty claim and made the necessary corrections for payment	21
1082924940	birthday rule	the technique used to determine a dependents primary and secondary ins. when they have two parents with ins. polocies.	22
1082934688	A listing of physician fees	Fee Schedule	23
1082934689	pre-existing condition	condition that exists prior to a new ins. policy	24
1082934690	EOB	explanation of benefits, a letter given to doctor and patient which has the charges, allowed amt for services rendered.	25
1082934691	clean claim	claim with no errors, omissions, fraudulent information.	26
1082934692	dirty claim	claim with errors, omissions, fraudulent information.	27
1083013508	Medicare Part A	covers hospital expenses	28
1083013509	Medicare Part B	covers medical visits	29
1083013510	Medicare Part D	covers prescriptions	30
1083013511	99204	example of a CPT-4 code	31
1083013512	401.9	example of a ICD-9 code	32
1083236704	O.V.	office visit	33
1083236705	T.O.S.	type of service	34
1083236706	P.O.S.	place of service	35
1083236707	HMO	health maintenance organization	36
1083236708	PPO	preferred provider organization	37
1083236709	N.F.	no fault	38
1083236710	any changes performed on a patients account	adjustment	39
1083236711	30-90 days	claims submission time	40
1083236712	L.E.	life expectancy	41
1083236713	Hospital benefit	medical coverage for a hospital stay	42
1083236714	inpt.	in patient (patient is staying over night in the hospital)	43
1083236715	est. pt.	a patient that has been seen at least once	44
1083236716	N.P. or initial	means new patient (never been seen before)	45
1121677307	P.F.	problem focused, Level I	46
1121677308	E.F.	expanded focused, Level II	47
1121677309	Low	routine, 20-30 mins	48
1121677310	Moderate	30-45 mins	49
1121677311	High	45-1 hour or more	50
1121677312	Form given to obtain information regarding pts CC in a specialties office	Questionnaire	51
1121677313	Form used to document all CC, vitals, and etc	Progress Notes (3rd form)	52
1121677314	Form that has all patient history	History Form (2nd form)	53
1121677315	Social Hx	sex, smoking, drugs, alcohol, other activities	54
1121677316	Work Hx	job activities or exposures	55
1121677317	Medical Hx	has information from all medical issues from birth to present day	56
1121677318	Family Hx	medical history regarding your family blood line	57
1121720250	F/U	follow up	58
1121720251	E/M	evaluation and management first section of the CPT-4	59
1121720252	Index	located in the back of the CPT-4 book	60
1121720253	Anesthesia	second section of the CPT-4 book, where codes are found for anesthesia, numbing agents	61
1121720254	Surgery	largest section in the CPT-4 book and lists procedures regarding all 12 body systemt	62
1121720255	Radiology	section of the CPT book that refers to nuclear medicine, sonography procedure codes	63
1121720256	Pathology & Laboratory	section of the CPT book that has codes regarding laboratory or pathology such as: urinalysis and hematology	64
1121720257	CPT-4 Book has	Six sections excluding the index	65
1121720258	ICD-9 Book has	three volumes I, II, III	66
1121720259	Modifiers	are two digit codes that attach to CPT-4 codes to express specificity	67
1121725794	UB-04 form	used to bill for hospital claims	68
1121725795	Encounter form used in the hospital	Charge Master	69
1121725796	Consultation	is an examination with a specialist	70
1121725797	In patient	means overnight stay at a hospital	71
1121725798	Out patient	having an exam or test in a hospital and able to return home afterwards	72
1131169623	MCR covers__________ of a claim	80%	73
1131169624	MCD usually is the ___________ ins, alongside MCR	supplemental	74
1131169625	_________has six sections excluding the index	CPT-4 Book	75
1131169626	_________ has 3 volumes	ICD-9 Book	76
1131169627	Volume II has____________	the Tabular list which is used to verify ICD-9 codes	77
1131169628	HCPCS codes	are used in hospital billing	78
1131169629	Volume I has ______________	the alphabetic index of the ICD-9 book	79
1131185829	The largest section in the CPT-4 book	Surgery due to the 12 body systems	80
1131185830	The last section of the CPT-4 book	index, located in the back of the book	81
1131185831	The third section in the CPT-4 book	Surgery	82
1131185832	The section in the CPT-4 book where codes begin with two zeros	Anesthesia	83
1131185833	The section in the CPT-4 book where codes begin with the digit seven	Radiology	84
1131185834	The section in the CPT-4 book where codes begin with the digit eight	Laboratory & Pathology	85
1131185835	The section in the CPT-4 book where codes begin with the digit nine	Medicine	86
1801816381	UB-92	old claim form used for hospital claims	87
1801816382	UB-04	new claim form for hospital claims	88
1801816383	MCO	ensures insurance affordability	89
1801881971	Medicare PART C	part of advantage care plan	90

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