Medical Billing 2,3,4

Front 1

Mrs. Caulfield is an 80-year-old female with Medicare as her primary insurance carrier. Mrs. Caulfield also has Metlife to cover her Medicare annual deductible and 20% of charges not covered by medicare. Metlife is a type of _____________ policy for Mrs. Caulfield.

Back 1

medigap

Front 2

A medical discount card is or is not a health insurance ID card

Back 2

is not

Front 3

Suzie Smith pays $25 at each office visit to her primary care provider. This amount is her responsibility to pay per her insurance coverage. This type of payment before each office visit is called a _______.

Back 3

copay

Front 4

Preferred provider organizations (PPO) and health maintenance organizations (HMO) are examples of ____ ____ ____.

Back 4

managed care plans

Front 5

A medical insurance coverage policy requires the policyholder to pay a monthly ______________.

Back 5

premium

Front 6

Medicare is a type of ________ insurance plan

Back 6

managed care

Front 7

Medigap is or is not a type of primary insurance coverage

Back 7

is not

Front 8

The amount of a patient's co-payment is found on his or her ___ ___ ____.

Back 8

insurance ID card

Front 9

A 25-year-old single female has coverage with her employer. This person does not have any children. She has a(n) _______________ type of insurance

Back 9

individual

Front 10

Why is it important to copy both the front & back of an insurance card?

Back 10

The front contains billing info such as group and policy numbers, subscribers, etc. The back contains the address to which you submit claims.

Front 11

A patient who has no health insurance is called

Back 11

self pay

Front 12

The insurance that is billed first for the patient is called

Back 12

primary

Front 13

Another name for secondary insurance is

Back 13

supplemental

Front 14

List three synonyms for the term policyholder

Back 14

subscriber, beneficiary, insured

Front 15

Describe the difference between co-payment and co-insurance

Back 15

Co-payment is the set amount a subscriber pays for each service, while a co-insurance is a set percentage the insured pays of the cost of each service

Front 16

A nongovernmental plan that usually pays 80 percent and makes the patient responsible for 20 percent is called an _____ plan

Back 16

indemnity

Front 17

CMS stands for

Back 17

Centers for Medicare and Medicaid Services

Front 18

2 plans regulated by CMS are

Back 18

Medicare, Medicaid

Front 19

CMS contracts with a ____ to pay Part B claims

Back 19

carrier

Front 20

List 3 types of medical care plans that require a patient to pay a co-payment

Back 20

PPO, HMO, POS

Front 21

List 5 types of managed care plans

Back 21

HMO, PPO, POS, Medicare managed care plan, Medicaid managed care plan

Front 22

Describe the difference between in network and out of network

Back 22

In network means the medical providers you are visiting are contracted into your managed care plan, while out of network means that they are not.

Front 23

Describe what capitation means and list an advantage and disadvantage of capitation

Back 23

Capitation means a monthly payment is being made to a provider for patients seen within an HMO plan. The advantage being if patients are not seen in that month the provider will still see payment, the disadvantage being if the provider sees a patient multiple times the amount paid does not increase.

Front 24

Describe fee-for-service arrangements

Back 24

System in which the physician is paid a specific amount for each service

Front 25

Some plans require that a patient obtain a _____ to see a specialist

Back 25

referral

Front 26

Name 3 types of Tricare plans

Back 26

Tricare Prime

Tricare Standard

Tricare Extra

Front 27

Which 2 Tricare plans are available only to retired service members and their families

Back 27

Standard, Extra

Front 28

Two health plans that refer to their members as beneficiaries are ___ and ___

Back 28

Medicare, Tricare

Front 29

Give an example of new health insurance coverage that some insurance companies now offer

Back 29

employee/significant other

Front 30

Which health insurance plan premiums increase as the family size increases

Back 30

Medicaid Managed Care Plan

Front 31

Describe what a medical discount card is and how it differs from the health insurance ID card

Back 31

A card that a patient can receive a discount from on services if the provider participates. No money is paid for the services like in an insurance situation.

Front 32

Numbers, letters, or a combination of both describing procedures, services, and diagnoses are called

Back 32

codes

Front 33

The coding system used to report services, supplies, injections/medicine, and durable medical equipment

Back 33

HCPCS

Front 34

The coding manual that includes Evaluation and Management codes (99201-99499) is the

Back 34

CPT manual

Front 35

A modifier is a _____ character _____, ____ or _________ descriptor

Back 35

2

alpha, numeric

alpha-numeric

Front 36

4 examples of modifier usage

Back 36

An additional service was performed

Unusual events occurred

Referencing a specific body site

Only part of a service was performed

Front 37

These codes are easily identified due to the alphanumeric nature, i.e. J3265

Back 37

HCPCS

Front 38

Procedures and E/M codes are reported using

Back 38

CPT aka Level 1 codes

Front 39

2 types of modifiers are

Back 39

CPT & HCPCS

Front 40

A ______ modifier can be used with either a CPT or national code

Back 40

HCPCS

Front 41

Code used to report Diagnosis is an

Back 41

ICD-9 code

Front 42

Name the 2 volumes of ICD-9-CM used for physician billing

Back 42

Volume 1

Volume 2

Front 43

Which volume of the ICD-9 manual is alphabetical

Back 43

volume 2

Front 44

Codes used to report external causes of injury are called

Back 44

E-codes

Front 45

Codes used to report a patient seen for a reason other than injury or disease

Back 45

V-codes

Front 46

Accurate coding reduces the risk of

Back 46

audit from insurance companies

Front 47

A new patient is one who has never been seen or who has not been seen in the past _____ _____

Back 47

36 months

Front 48

Another name for the superbill

Back 48

encounter form

Front 49

Superbill

Back 49

form listing CPT, HCPCS, and ICD-9 codes used to record services performed for the patient and the patient's diagnosis(es) for a given visit

Front 50

Privacy enforcement in the office is regulated by

Back 50

HIPAA

Front 51

History, physical exam info, and diagnoses related to a patient are kept in the

Back 51

medical chart

Front 52

Person responsible for assigning an ICD-9 code on a superbill

Back 52

The coder or the physician

Front 53

Codes used for hospital visits are found on the

Back 53

hospital sheet

Front 54

What is the importance of a thoroughly completed patient registration form?

Back 54

A thoroughly completed registration form will provide additional contact information if the need for collection arises

Front 55

How might a physician present his hospital billing to the medical biller if a hospital sheet is not used

Back 55

On the admit/discharge sheet

Front 56

How does the frequency of billing vary from office to office, or if working for a medical billing company?

Back 56

Some may submit claims daily, once a week, or twice weekly. Medical billing companies may submit on a weekly basis.

Front 57

Index to diseases

Back 57

ICD-9-CM Volume 2

Front 58

ICD-9-CM volume 3

Back 58

used to code "inpatient" hospital procedures

Front 59

Each procedure code ______ ___ ____to a diagnosis code on the claim form

Back 59

must be linked

Front 60

Evaluation and Management (E/M) codes for Office visits distinguish patients as

Back 60

New or Established

Front 61

For an office visit an ___________ or ________ is used to record CPT and ICD-9 codes

Back 61

encounter form , superbill

Front 62

HIPAA is defined as

Back 62

Health Insurance Portability and Accountability Act

Front 63

This sheet is generated at hospital release and lists patient demographic information

Back 63

Admit/discharge sheet

Front 64

Dr. Baker sees eight patients on her rounds at a local hospital. Which individual would typically complete the hospital billing sheet for these eight patients?

Back 64

Dr. Baker

Front 65

In relation to Tricare Prime, the insurance coverage for military personnel, what does the acronym MTF mean?

Back 65

Military Treatment Facility

Front 66

A _________ is when a patient is referred to a provider (usually a specialist) for their "opinion or advise" regarding the patients illness/ disease or injury at the request of another provider these services can be rendered in the hospital or in an office setting.

Back 66

consult(ation)