Medical Insurance, Billing, and coding Flashcards

12420579806	EIN	Employer identification number	0
12420588363	LOS	length of stay	1
12420593163	PF	problem focused	2
12420601720	SOF	signature on file	3
12420606804	allowed charge	the maximum amount dollar amount an insurance will cover for provided service	4
12420664859	Coordination of Benefits (COB)	explains how an insurance policy will pay if more than one policy applies	5
12420683810	fee profile	charges a physician usually charges	6
12420688007	Fee scheduler	Insurance allows to pay	7
12420696905	fiscal agent	an organization that processes claims for a government program	8
12420707345	Guarantor	insured or subscriber of the account .	9
12420715756	Preauthorization	Prior approval for treatment and procedures	10
12420715757	Precertification	amount pay for the treatment thats need to be approved	11
12420734088	professional courtesy	reduction or absence of fees to professional associates	12
12420743226	rider	an addition done to an insurance usually first 6 months	13
12420758801	UCR	usual, customary, and reasonable	14
12420793857	HMO (Health Maintenance Organization)	Health insurance that requires a PCP and wants you to use only in-network doctors	15
12420798617	PPO (Preferred Provider Organization)	Health insurance that makes it easier to see out-of-network doctors.	16
12420804445	EPO	in network only, out of network only in case of emergency	17
12420831500	IPA	Formally organized groups of MDs working independently, mds paid by subscriber,	18
12420852357	Medicare	65 years old, with minimum of 10 year of medicare approved, disabled, end-stage of kidney , kidney donor, retire railway employee	19
12420892489	Level 1 codes	CPT CODES (numbers)	20
12420897295	Level II CODES	National codes (letters)	21
12420912985	Category 1 codes	procedures/services identified by a 5 digit CPT code and descriptor nomenclature;	22
12420916670	Category II	Supplemental codes that can be used for performance measurements	23
12420923260	Category III Codes	temporary codes for emerging technology, services, and procedures	24
12420933931	99 CODES	Special report must come with the submission	25
12420948143	modifier	do not change code just add any specifics	26
12420957603	Bundling	one CPT code is used in place of multiple	27
12422579489	establish pt	seeing within 3 years	28
12422582630	New pt	After 3 yrs. of not seen in the office.	29
12422624716	the internal classification of disease , tenth revision (icd-10)	inpatient procedure codes	30
12422629535	National Center for Health Statistics (NCHS)	outpatient diagnostic care	31
12422655861	NEC	Specific code not available	32
12422657892	NOS	unspecified	33
12422674725	late effects	No time limit requires two codes. acute condition caused another is now done.	34
12422682421	principal diagnosis code	reason why pt was admitted to hospital. inpatient setting	35
12422745782	cycle billing	pts A-F billed the same time of thee month, more cash flow	36
12422759087	types of payments	at time of visit, bill with credit extension, insurance, outside collection agency	37
12422769779	collection agency	keeps 40 to 60%, last resort	38
13097534427	HSA (Health Savings Account)	used in association with a medical plan that carries a high deductible	39
13097536472	indemnity	specific dollars amount paid for each service	40
13097553930	TRICARE	Covers families of military active personnel and retirees.	41
13097558868	Tricare Options	Prime,(HMO) extra(Managed care network providers), standard(fee for service plan)	42
13097565513	CHAMPVA	Covers disabled veterans, covers families who lost relative	43
13097584989	two sections for CPT,ICD codes	alphabetic index, tabular index	44
13097590089	Evaluation and Management	99201-99499	45
13097592559	anesthesiology codes	00100-01999,99100-99140	46
13097594486	Surgery Codes	10021-69990	47
13097596447	Radiology Codes	70010-79999	48
13097597281	Pathology and Laboratory codes	80049-89400	49
13097600067	Medicine codes	90281-99199	50
13097632577	ICD Codes (International Classification of Diseases)	made up of numbers and letters. 4-7	51
13097659805	place holder	X character	52
13097663224	primary diagnosis code	chief complain outpatient setting	53
13097874025	HCPCS codes	for injections, meds to medicare pts	54
13097882987	Parentheses	enclosed extra information	55
13097892989	ICD Codes	a-z except U	56
13097902817	CODES A-B	Infections	57
13097904431	Codes C-D	Neoplasm	58
13097906156	Codes D-D	Blood, immune	59
13097909031	Codes E-E	Endocrine, Nutrional, Metabolic	60
13097914937	Code F-F	Mental and Behavior disorder	61
13097921229	Code G-G	Nervous system	62
13097927990	Code H-H	Eye, Ear, Masteoid	63
13097931211	Code I-I	Circulatory System	64
13097932874	Code J-J	Respiratory	65
13097933945	Code K	Digestive	66
13097934903	CODE L	SKIN	67
13097937348	CODE M	MUSCULAR and connective	68
13097942133	Code N	Genitourinary	69
13097945606	Code O	Pregnancy, childbirth	70
13097948234	Code P	Perinatal period	71
13097951640	Code Q	congenital Malformation deformation	72
13097954724	Code R	symptoms, signs, and abnormal clinic	73
13098004821	Code S-T	Injury and poisoning	74
13098007447	Code V-Y	External causes of mobility	75
13098009995	Code Z-Z	Health services	76
13098012275	Medicare Part B	voluntary	77
13098015616	medicare Part A	Automatic enrollment	78
13098022633	medicare D	Prescription drug coverage	79