Insurance and Coding Final Review

heyguysitsclaire's version from 2016-04-05 19:16


Question Answer
CHAMPVA Department of Veterans Affairs program
TRICAREhealth care program for active and retired military personnel and their dependents, survivors and certain former spouses.
MedicaidLow Income individuals or families
Medicare65+ years and certain younger people with disabilities
Which Insurance company would be primary?The one that pays first, the secondary would be the one that pays in case the first one can't pay the entire thing
What is the birthday rule and how does it work?In a family, if both of the child's parents have different health insurance, the child would use the parent's health insurance whose birthday falls closer to the beginning of the year
Fee For ServiceWhere services are unbundled and paid for seperately
Managed CarePatients agree to only visit certain doctors and hospitals
What is COBRA and how does it work?Consolidated Omnibus Budget Reconciliation Act .Meant to provide an element of financial security to workers who would otherwise lose coverage because of a layoff, divorce or other event.
How is ICD 10 coding done?Determine diagnosis, locate main term, add modifiers if needed. WHO. More so for identifying diseases and accidents
What are Z codes in ICD 10Reason for Encounter
How does CPT coding work and what is it?manual containing a list of descriptive terms and identifying codes used in reporting medical services and procedures performed and supplies used by physicians and other professional health care providers
What are modifiersan agent or method that causes something else to change.
What is modifier 99reportable with all procedure codes, and you might use it when it is necessary to indicate more than four modifiers on a single detail line or service.
What does x represent in ICD codinga placeholder
What is CMS and what does it doAgency within the US Department of Health & Human Services responsible for administration of several key federal health care programs. Medicare, Medicaid, CHIP, HIPAA and CLIA
How do you fill out CMS 1500 forms

Section 2

Question Answer
Medicare Part AHospital Insurance
Medicare Part BMedical insurance;includes healthcare provided in clinics
Medicare Part CMedicare Advantage Plans
Medicare Part DPrescription dug progrom
How does UCR Work?usual, customary and reasonable as being "The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount."
Date of ServiceThe date the insured was seen by a health care practitioner or given medical treatment.
Advance Beneficiary NoticeForm that medicare requires all health care providers to use when medicare does not pay for the service
CopayAmount of money the patient has to pay out of pocket before the insurance company begins to pay
CoinsuranaceType of cost sharing between the the insurance provider and the policy holder
Third Party AdministratorPerson or organization who processes claims and performs other contractual administrative services
DeductibleCertain amount of money that the patient must pay each year toward his or her medical expenses before health insurance benefits begin
PremiumA periodic fee that a fee-for-service policy holder has to pay to the insurance company in exchange for financial protection against loss
Assignment of BenefitsArrangements by which a patient requests that his or her health insurance benefit payments be made directly to a designated person or facility
Policy HolderIndividual in whose name the policy is written; the insured