Health Insurance, Procedural, and Diagnostic Coding Flashcards
This type of insurance is established for the splices and dependents of veterans who have total permanent service connected disabilities
CHAMPVA
What is a condition called that has existed before the insurance policy had been put into effect
Preexisting condition
What is the name of the person who is insured or called the policyholder
Subscriber
This type of insurance purchased by an individual or family that does not have access to a group health insurance
Individual insurance
This is a specified amount that the insured must pay toward the charge for professional services rendered at the time of service
Copayment
This is insurance offered to all employees by the employer
Group insurance
This type of insurance was established to aid dependents of active service personnel, retired service personnel and those who died an active duty
TRICARE
This is a government insurance program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, injuries or illness
Worker’s Compensation
What are ICD codes descriptive of
Descriptive codes that present a disease or condition
If a record is reviewed by a third-party payer and a procedure was never documented it means that
It did not happen
When must any new, revised, or deleted codes be implemented
January 1
Who publishes the Current Procedural Terminology Manual
American Medical Association (AMA)
Why is the ICD-9CM manual running out of capacity
It’s obsolete and no longer reflects the current modern practice of medicine;
The code structure doesn’t allow for the medical advances
Who records the services performed on an encounter form
The physician (Provider)
Most physicians utilize what volume of the ICD-9 manual
ICD-9CM with volumes one and two
What is the name for the date when insurance policy goes into effect
Effective date
This time of insurance entitles members to services provided by participating hospitals, clinics, and physicians
Health Maintenance Organization (HMO)
What are the procedures used to ensure no duplication of payment on claims when a patient has more than one insurance
Coordination of benefits
This is a predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness
Deductible
What is a service area
Geographic area served by an insurance carrier
What is the approval obtained before the patient is admitted to the hospital or receives specified outpatient in office procedures called
Per-certification
What is the name for a plan that the health care delivery system combines the delivery of healthcare and payment of services
Managed care
What is assignment of benefits
Authorization by the patient to allow the doctor to get paid directly from insurance companies
This is an insurance plan for the medical care of low income population
Medicaid
