INTRODUCTION TO MEDICAL BILL AND CODING

Question 1

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

Answer 1

Organize all patient records, bills, and statements

Question 2

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?

Answer 2

Financial; services; conditions; will not; responsibility

Question 3

• 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)

Answer 3

Of front and back; (name,address, etc); by the practice; New patient; financial; (NPP); releases

Question 4

Treatment authorization

Answer 4

(Physician/patient contract; this contract begins when the physician agrees to treat the patient.

Question 5

After the patient has seen the medical staff, they will return with an —————- listing the diagnosis and the procedure taken to treat

Answer 5

Encounter form ( also known as a superbill )

Question 6

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.

Answer 6

Post charges, ICD- 9 code

Question 7

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.

Answer 7

Attach supporting documentation; reprint the claim and therms then Attach documents that support the claim

Question 8

1966

CPT was developed by the ——————————- including E/M (Evaluation and Management) section.

Answer 8

American Medical Association

Question 9

1989
————————————-, known as The Stark Law after Rep. Pete Stark sponsored the original bill. it prohibits Physicians from profiting from referrals and kickbacks.

Answer 9

Ethics in Patient Referrals Act.

Question 10

ICD

Answer 10

Coding changes every 10 years

Question 11

DRG

Answer 11

Diagnosis Related Group

Question 12

CMS

Answer 12

Center for medical systems

Question 13

Abuse

Answer 13

A corrupt practice or custom

Question 14

Deductible

Answer 14

A clause in an insurance policy that relieves the insurer of responsibilities for any initial specified loss of the kind injured against.

Question 15

Fraud

Answer 15

Intentional perversion I’d the truth in order to induce another to part with something of value or to surrender a legal right.

Question 16

Authorization

Answer 16

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.

Question 17

Clearing house

Answer 17

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

Question 18

Disability insurance

Answer 18

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.

Question 19

HIPAA

Answer 19

Health Insurance Portability Accountability Act

Question 20

Federal False Claims Act

Answer 20

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

Question 21

Fair Credit Bill Act

Answer 21

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.

Question 22

Fair Debt Collection Practice Act

Answer 22

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

Question 23

Truth in lending Act

Answer 23

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

Question 24

Assignment of Benefits

Answer 24

Also known as payment authorization authorizes their insurance benefits to be paid directly to the medical provider.