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Medical Billing & Coding Flashcards

MA290

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6995896665AjudicationFinal determination involving settlement of industrial accident.0
6995896666OSHAOccupational Safety and Health Administration1
6995896667NPINational Provider Identifier2
6995896668SOAPSubjective, Objective, Assessment, & Plan.3
6995896669NOSNot Otherwise Specified4
6995896670NECNot Elsewhere Classified5
6995896671True or False. Are worker's compensation records kept in a separate chart or patient's personal chart if they see their own provider for worker's comp. services?TRUE6
6995896672What are supplementary reports and when are they filed for temporary disability insurance claims?They are progress notes which are filed after every visit.7
6995896673In worker's compensation case, the contract and financial responsibility is between who?Insurance company and the physician8
6995896674True or False. For patients receiving VA medical care, travel expenses to and from a facility is a benefit.TRUE9
6995896675True or False. California allows for state disability benefits in normal routine pregnancy.TRUE10
6995896676Where are disability insurance available from, what sources?Federal, government, state, employer sponsored, and or private insurance.11
6995896677What is one of the most important items needed on a state disability claim from?Social Security Number12
6995896678Compromise and ReleaseWhen a case is rated for permanent disability and settled.13
6995896679What is the simplest type of worker's compensation claim?Non- disability14
6995896680What do worker's compensation benefits include?Medical treatment, financial, rehab benefits, disability, death.15
6995896681In many states, worker's compensation laws have exemption for certain occupations such as?Gardeners, baby sitters,and domestic help.16
6995896682Premiums for worker's compensation insurance are paid by:The employer.17
6995896683What are the reasons for worker's compensation laws?Ensure employee returns to work promptly, to provide income, encourage employer interest in safety.18
6995896684A person who is retired from a career in the armed forces is eligible for TRICARE until 65 years of age?Yes and then at the age of 65 they get Medicare19
6995896685What is CHAMPVA?A service benefit program.20
6995896686How does a person qualify for CHAMPVA?Program is for: spouse or kids of veterans with total, permanent service connected disability or surviving spouse or kids of veteran who died from service connected to a disability.21
6995896687Who can treat CHAMPVA patients?Freedom of choice in selecting their civilian health care providers. VA & military base doctors.22
6995896688How and who administers Medicaid benefits?The state with federal guidelines handle it.23
6995896689What individuals qualify for Medicaid benefits?Certain needy and low income people, pregnant, such as elderly (65+), blind, disabled, members of families with dependent kids deprived of support of at least one parent. Only for US citizens.24
6995896690What benefits are available through Medicaid?Family planning, home health care, immunization, lab, x-ray, hospice, Rx drugs, dental, etc.25
6995896691Who is eligible for Medicare benefits?65 and older retired on social security, 65+ retired from railroad/ civil service, disabled, kids or adult with chronic kidney disease, and kidney donors.26
6995896692What are the different types of coverages Medicare provides?Medicare Part A: hospital coverage, nursing facility, home healthcare services, psychiatric hospital, and respite care. No matter what ,at age 65, you must take this part. Medicare Part B: outpatient coverage or medical advantage. Medicare Part C: supplemental coverage. Covers what other parts doesn't. Medicare Part D: prescription drugs.27
6995896693Who administers Medicare?The Federal government.28
6995896694What are the two types of bankruptcy?Chapter 7: can liquidate assets to pay for what you owe. Chapter 13: payment arrangements. Also known as wage earners bankruptcy.29
6995896695What is small claims court?Gives 'lay' people access to court system without a lawyer. Some advantages are the modest filing fees, less paperwork, no lawyer, and short time frame from filing to actual trial. For amounts less than $5,000.30
6995896696When insurance carriers don't pay claims in a timely manner, what effect does this have on the medical practice?Decreases cash flow (which is usable cash, money on hand).31
6995896697What does professional courtesy mean?Discount or exemption for charges at discretion of the doctor. Making no charge to anyone, patients or insurance company for medical care.32
6995896698What is the first level of appeal in the Medicare program?Redetermination (phone)33
6995896699True or False. Routine use of too many non-specific diagnostic codes may result in downcoding.True.34
6995896700What are non-specific codes anything other than an injury or illness called?Z codes35
6995896701An insurance claim submitted with errors is referred to as?Dirty claim.36
6995896702A code or codes that further explain or add additional detail to a CPT code is known as a:Modifier37
6995896703What does bundling mean?Grouping codes that are related to a procedure.38
6995896704Key components that determine an evaluation and management code are documented by who?The physician39
6995896705How often are CPT & ICD codes updated?Annually or yearly.40
6995896706What are neoplasms?New or abnormal growth of tissue.41
6995896707What are codes called that are used primarily by cancer and tumor registries?Morphology codes42
6995896708True or False. It is possible to for primary diagnosis and the principal diagnosis to be the same.TRUE43
6995896709True or false. We can code for symptoms.True.44
6995896710True or false. A condition be both acute and chronic at the same time.True.45
6995896711What is the term used as a name of a disease, structure, operation, or procedure, usually derived from the name of a place or person who discovered or described it first.Eponym.46
6995896712True or false. Burns are reported based on the depth & extent of the burn, and the agent that caused the burn.True.47
6995896713Know the difference between principle, primary, and secondary diagnosis.Principle diagnosis: comes after further testing. Example: asthma Primary diagnosis: reason why you came in. Example: shortness of breath. Secondary diagnosis: caused by primary diagnosis. Example: wheezing.48
6995896714What do diagnostic codes explain?What was wrong with the patient.49
6995896715What do procedure codes explain?What we did for the patient.50
6995896716What is the birthday rule?Whose ever birthday comes first within the year (by month and day if needed), or whoever had the insurance the longest or first. Determines what is primary and secondary insurance.51
6995896717What is the reason for coordination of benefits statement in a health insurance policy?To avoid something being billed twice or duplication of claims.52
6995896718When does the physician- patient contract begin?When the patient makes the appointment! When the doctor accepts and agrees to see the patient.53
6995896719Most physician- patient contracts are:Implied.54
6995896720True or false. Confidentiality between the doctor and patient is automatically waived when the patient is being treated in a worker's compensation case.True.55
6995896721Submitting a claim for services thats not medically necessary is a violation of what Act?False claims act56
6995896722What penalties might be incurred for illegally coding claims?Jail,fines, lose license/ suspended.57
6995896723True or false. Physicians are legally responsible for any actions of their employees performed within the context of their employment.true.58
6995896724What does cash flow mean?Ongoing availing of cash in the medical practice.59
6995896725What does confidential information include?What's seen, written, or heard.60
6995896726What are medical ethics?Standards of conduct.61
6995896727What's an encounter form and are there at least two other names it could be called?Proof of care for the day, like a check off list of what was done. Also known as super-bill and charge slip.62
6995896728What's assignment of benefits?Transfer of ones legal right to collect an amount payable under an insurance contract.63
6995896729What are the reasons to document patient encounters?To protect yourself. It is wasn't written, it didn't happen! Support reasons why we are billing what we are billing,g and ensures standards are being met.64
6995896730What are differences between a new patient and an existing patient?A new patient is somebody who is new to the practice or has not been seen in 3 years. An existing patient has been seen before. Even if they have seen by one doctor in the practice, and sees another before the 3 year mark, Within the same practice.65
6995896731true or false. A problem- focused exam (focus on one thing) is more complex than a detailed exam (more intensive).False.66
6995896732When a discussion takes place with a patient concerning risks and benefits of treatment options, it is considered what?Counseling67
6995896733A daily record sheet used to record daily business transactions is called?A day sheet68
6995896734True or false. An insurance billing specialist can escape liability by pleading ignorance.False.69
6995896735True or false. Personal insurance is usually less expensive than other health insurance.False.70
6995896736True or false. Information such as deductible, copayment, pre- approval, and insurance company address and telephone number can USUALLY be found on the insurance card.True.71
6995896737What information can be found on an insurance card?Member ID number, insurance billing address & number, insurance name, deductible, copayment, member name.72
6995896738Front office medical duties have become increasingly important because:Diagnostic and procedure codes must be reviewed for completeness and correctness.73
6995896739True or false. The injured worker, does NOT have the right to be evaluated by a doctor who is NOT assigned by the employer.False74
6995896740True or false. It is believed that the longer the workers compensation patient is out or work, the better they will get.False.75
6995896741True or false. It is possible for a Medicaid patient to be on Medicaid one month and off the next.True.76
6995896742How many payment installations must there be to have full disclosure?4 or more.77
6995896743When collecting fees, you goal should be to:Collect all of it! 100%78
6995896744If you cannot collect the whole fees amount, what amount should you collect?90% of it.79
6995896745Who assigns the employer ID number?IRS80
6995896746What is it called when a group of insurance claims is sent all at once from your office?Batch81
6995896747E/M.Evaluation & Management.82
6995896748Why would we use diagnostic codes to describe symptoms?Because we do not have a definitive diagnosis yet.83
6995896749True or false. Neoplasm is a new growth or abnormal tissue, which can be benign or malignant.True.84
6995896750What is a person called who is a patient with insurance?Subscriber, member, insured, or a policy holder.85
6995896751Confidentiality is automatically waived when it comes to:Gunshot wounds, child abuse, elder abuse, domestic abuse, and extreme contagious diseases. This is done to protect the community.86
6995896752True or false. The patient has the right to get a copy of his or her patient information or record.True.87
6995896753What is the age limit under the Affordable Care act?2688
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