Medical Billing and Coding Pt 4 Flashcards
1
Q
- What does Medical part B cover that is considered medically necessary?
A
Physicians outpatient services
2
Q
- When billing a Centers for Medicare and Medicaid Services (CMS) program, what will happen to a claim if the most specific code available is not used?
A
Rejected
3
Q
- What program covers people who cannot otherwise afford medical care?
A
Medical
4
Q
- Name the 3 parties involved in the insurance plan
A
The patient subscriber and policy holder the insurance company
5
Q
- What are CPT codes used for?
A
Procedures
6
Q
- What does the (+) sign indicate when added into CPT coding?
A
An add on code
7
Q
- Referrals are not required for which type of insurance plan?
A
PPO
8
Q
- What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?
A
Upcoding
9
Q
- Define unbundling.
A
Breaking a code down into multiple separate codes in order to receive a higher reimbursent.
10
Q
- What does a provider complete during/after a patient’s visit to summarize their billing information?
A
Encounter form
