Billing Flashcards
Medicare B
Physician and outpatient services.
How does a person become eligible for Medicare?
- Over 65
- Disabled
- End-stage renal disease
- Has Medicare through spouse
Medicaid
For indigent patients
Funded by federal and state
How are Medicaid claims paid?
Through fiscal agent
How is eligibility determined?
Eligibility category
Varies by state
Some require registering w a Medicaid managed care plan.
Managed care plans
Incur a copayment
HMO PPO POS Medicare managed plan
V codes
ICD 9 codes for preventative medicine and reasons other than disease or injuries.
Patient aging report
Shows patient balances due
Modifier
2-digit code showing that a service/procedure was altered by an unusual or specific circumstance
Legacy number
An ID# assigned to a physician that identifies the physician to payers.
Insurance adjustment
Dollars adjusted off pt acct = difference between fee for services billed and the insurance company’s allowed amt.
ICD 9 CM
International Classification of Diseases 9th revision Clinical Modification.
E codes
External injury
Poisoning
Other adverse reactions
EDI
Electronic data interchange
Define Indemnity Plan
After deductible is met, Reimbursement is 80%of allowed amount (of the insurance company’s fee schedule) and pt pays remaining 20% (aka co-insurance).
