Medical Billing Insurance Final Review @ LIBI Flashcards

4953212618	MCR	medicare	0
4953212619	MCD	medicaid	1
4953215818	allowed amount	the amount deemed appropriate to pay for svcs rendered by an ins company	2
4953225743	Part A	covers hospital	3
4953229845	Part B	covers outpt services or ov's	4
4953232924	Part C	advantage care	5
4953235030	Part D	covers prescription	6
4953252302	in pt.	in patient, person spending the night at a hospital	7
4953256105	out pt.	out patient, person not spending the night in a hospital	8
4953266393	CPT-4	current procedural terminology fourth edition	9
4953269548	ICD-9	international classification of diseases nineth edition	10
4953274337	ICD-10	international classification of diseases tenth edition	11
4953316221	capitation	a set fee paid to the physician whether patients are seen or not	12
4953365305	policy holder, subscriber, guarantor, insured, member	terms that refer to a person who holds insurance	13
4953367386	PPO	preferred provider organization	14
4953373315	HMO	health maintenance organization	15
4953376764	EPO	exclusive provider organization	16
4953381726	quality assurance	certificates, licenses, diplomas held by personnel to perform their jobs efficiently	17
4953395511	medi medi	persons who have both MCR & MCD insurances	18
4953408244	utilization review	method controlling healthcare costs and quality of care by reviewing necessity	19
4953413054	necessity	the linkage and supported procedure and diagnosis codes	20
4953431331	PCP	primary care physician or provider	21
4953438927	IDS	integrated delivery system	22
4953446491	PAR	participating provider	23
4953446492	NON-PAR	non-participating provider	24
4953449502	exclusion	insurance not covering procedures that are not found necessary	25
4953456615	POS	point of service, or place of service	26
4953458877	TOS	type of service	27
4953461611	DOA	dead on arrival or date of accident	28
4953463558	N.F.	no fault	29
4953463592	O.V.	office visit	30
4953466293	Est. Pt.	established patient (more than one visit)	31
4953469694	Consult	seeing a specilist	32
4953475438	TOP	is aka Cafeteria Plan, where one of the three types of ins is selected: HMO, PPO, EPO	33
4953480773	dirty claim	claim with errors, omissions, mistakes, fraudulant information	34
4953490655	clean claim	claim form with correct information that will be bill and processed	35
4953497355	claim submission	sending a claim out via electronically or via mail	36
4953504275	submission time	30, 90 or 120 days	37
4953509780	MCR coverage	80%	38
4953509781	Primary Ins	insurance that covers most of medical cost	39
4953514027	Secondary Ins	aka co-insurance picks up where primary left off	40
4953517842	Tertiary Ins	picks up, where secondary ins left off	41
4953533453	cms-1500 form	form used to submit	42
4991046935	WC	workers' compensation	43
4991048784	PAC	preadmission certification	44
4991051874	concurrent review	review of medical necessity of tests and procedures, ordered as a inpt hospitalization	45
4991060772	birthday rule	method used to determine a child dependent who's ins is her primary vs secondary based on parents birthday	46
4991067537	superbill	is aka encounter form- has commonly used CPT4 and ICD10 codes and some prices	47
4991074003	copayment	small fee paid upon every o.v.	48
4991076429	consult	being seen by a specialist	49
4991078944	demographics	term used to describe all pt. information	50
4991081922	writeoff	taking a financial hit, by adjusting the account to zero	51
4991087199	fee-for-service	physician charges a price for every service performed	52
4991092854	case management	development of pt. care plans for the coordination and provision of care for complicated cases in a cost effective manner.	53
4991103066	quality control	is guidelines ensuring the best medical care by making sure all equipment is in good working order	54
4991113735	NP	new patient (first time to a practice)	55
4991115880	NF	no fault (car accident)	56
4991119672	A/R	accounts receivable "monies made/earned"	57
4991122490	A/P	accounts payable "monies owed"	58
4991129360	gatekeeper	providing essential healthcare service at the lowest possible cost	59
4991132430	MCO	managed care organization (help to control healthcare costs)	60
6169364610	open claim	organized by mth and ins. co. and have been submitted to the payer but await processing	61
6169366923	malignant	cancerous, spreading, harmful cancer	62
6169367301	benign	non-cancerous, not spreading	63
6169369018	eponym	a dz, condition, disorder, and instrument or procedure named after a person	64
6169372763	reference terms	are placed to assist the coder in finding the proper codes	65
6169374046	CPT-4 book	has 6 sections excluding the index	66
6169394730	C.O.B.	coordination of benefits	67
6169396368	E/M	evaluation and management	68
6169398748	HIPAA	privacy act	69
6169399134	EHR	electronic health record	70
6169399865	EMR	electronic medical record	71
6169400568	ER	emergency	72
6169402799	BCBS	blue cross blue shield	73
6169404338	N.H.	Nursing home	74
6169406319	S.O.F.	signature on file	75
6169408060	MCO	Managed care organization	76
6169408541	NEC	Not Elsewhere Classified	77
6169409651	NOS	Not otherwise Specified	78
6169410269	P.F.	problem focused	79
6169411432	E.F.	expanded focused	80
6169411955	Low	20-30 (low complexity)	81
6169412378	Mod	30-45 (moderate complexity)	82
6169414586	High	45-1hr (high complexity)	83
6169415586	C.C.U	critical care unit or cardiac care unit	84
6224663244	E.O.B	explanation of benefits	85
6224667984	Discharge	being released from the hospital	86
6224668631	Admission	being admitted to the hospital	87
6225065445	Day sheet	monies collected for the day at a doctor's office	88
6225066908	Aging Report	a list of open or overdue amounts on patient or insurance accounts	89
6225069991	past medical hx	all the patients health statuses from birth to present date	90
6225072181	icd9 vs icd10	icd9 has 3-5 digits, icd10 has 10 characters	91