INTRODUCTION TO MEDICAL BILL AND CODING Flashcards
A medical and coding specialist’s basic responsibility is to
And make sure that they do not have any errors before coding in the information
Organize all patient records, bills, and statements
It is important to determine ———— responsibility for the visit by asking the following questions of the insurance company:
- What——— will be covered under the patients plan?
- What medical ————— establish medical necessity?
- What services ———— be covered?
- What is the patients —————————- payment?
Financial; services; conditions; will not; responsibility
- Make a copy of—————— of the insurance card as well as an official photo ID.
- Verify demographics (—————)
- Have patients complete all other forms required ——————- . These would include:
- ———— information form
- Acknowledgment of receipt of ———-
- Notice of Privacy Practices (—-)
- ————— (emails,records,etc)
Of front and back; (name,address, etc); by the practice; New patient; financial; (NPP); releases
Treatment authorization
(Physician/patient contract; this contract begins when the physician agrees to treat the patient.
After the patient has seen the medical staff, they will return with an —————- listing the diagnosis and the procedure taken to treat
Encounter form ( also known as a superbill )
Using the info from the encounter form:
Enter or ———- for services and/or procedures for each specific data of service,linking each one to an applicable —————-; e.g., you could link the ICD code for the flu to a CPT code indicating a flu shot was give.
Post charges, ICD- 9 code
Since most claims are now filed electronically, you are unable to ——————————— and will need to wait for request of info from each individual carrier. Once the carrier requests supporting documentation, —————- that support the claim, such as office visit notes, results from a lab, radiology service, operative reports, etc, according to their requests.
Attach supporting documentation; reprint the claim and therms then Attach documents that support the claim
1966
CPT was developed by the ——————————- including E/M (Evaluation and Management) section.
American Medical Association
1989
————————————-, known as The Stark Law after Rep. Pete Stark sponsored the original bill. it prohibits Physicians from profiting from referrals and kickbacks.
Ethics in Patient Referrals Act.
ICD
Coding changes every 10 years
DRG
Diagnosis Related Group
CMS
Center for medical systems
Abuse
A corrupt practice or custom
Deductible
A clause in an insurance policy that relieves the insurer of responsibilities for any initial specified loss of the kind injured against.
Fraud
Intentional perversion I’d the truth in order to induce another to part with something of value or to surrender a legal right.
Authorization
An individuals formal or written permission to use or disclose his personal identifiable health info for purposes other than treatment, payment, or health care operations.
Clearing house
Am I dependent organization that receives insurance claims from the physicians office and performs software edits and redistributes the claim electronically to various third party payers
Disability insurance
Reimbursement for income lost as a result of temporary or permanent illness or injury. Disability Insurance paid only if individual:
1. Is unable to do regular or customary work for a certain number of days.
2. Was employed when disabled.
3. Was under the care and treatment of a licensed provider during initial disability and
continues care with the same.
4. Processes a claim within a certain number of days after the date the individual was
disabled.
5. Has the licensed provider complete the disability medical certification documents.
HIPAA
Health Insurance Portability Accountability Act
Federal False Claims Act
Federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program
Fair Credit Bill Act
The Fair credit Billing Act is a 1947 federal law designed to protect consumers from unfair credit billing practices the detail all of the rights you have as a consumer to dispute things like unauthorized charges due to errors undelivered goods or service.
Fair Debt Collection Practice Act
The fair Debt Collection Practices Act specifies that debt collectors cannot contact debtors at inconvenient times. That means they should not call before 8am or after 9pm
Truth in lending Act
The truth un lending act of 1958 is a United States federal law designed to promote the informed use of consumer credit, by requiring disclosure about it’s terms and cost to standardize the way costs associated with borrowing are calculated and disclosed
Assignment of Benefits
Also known as payment authorization authorizes their insurance benefits to be paid directly to the medical provider.
