Office Financial Management, Billing & Insurance Flashcards

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1
Q

Bookkeeping

A

Record of financial transactions.

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2
Q

What are the 5 types of transactions?

A

1) Asset - resources
2) Liability - debts
3) Income - revenue
4) Expense - purchases
5) Equity - earnings

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3
Q

Double-entry Bookkeeping

A

Every transaction effects 2 accounts by increasing one & decreasing the other.

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4
Q

Fee Schedule

A

A complete listing of fees that are used to pay doctors or other providers/suppliers

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5
Q

Resources-based Relative Value Scale

RSBRVS

A

A payment system that is used to calculate medical payments for physician services by the CMS.

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6
Q

Diagnosis-Related Groups

DRGs

A

CMS pays for inpatient care based on principle diagnosis, age, and other complicating issues.

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7
Q

Contracted Fees

A

A benefit plan that prohibits extra billing.

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8
Q

What does CMS stand for?

A

Centers for Medicare & Medicaid Services

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9
Q

ICD-10-CM stand for

A

International Classification of Diseases, 10th Revisions, Clinical Modification.

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10
Q

HCPCS stand for

A

Health Common Procedure Coding System

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11
Q

CPT stand for

A

Current Procedural Terminology

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12
Q

Purpose of HCPCS

A

Used to fill claims for equipment, supplies and services that are not covered by CPT codes.

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13
Q

What is CPT?

A

A primary code system used to describe the treatment services provided for that diagnosis.

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14
Q

HCPCS Level 1

A

Identical to CPT codes, b/t when used bill Medicare/Medicaid it will used HCPCS codes.

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15
Q

HCPCS Level 2

A

Designed to represent non-physician services & supplies (e.g., ambulance) that aren’t covered by HCPCS Level 1.

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16
Q

Who’s eligible for Medicare?

A

1) 65+ year old
2) Disability person who has received Social Security benefits for 2 years.
2) Anyone with End Stage Renal Disease (ESRD)

17
Q

Who’s eligible for Medicaid?

A

1) Low-income persons
2) Children who qualify for public assistance.
3) Disability

18
Q

Medigap Policy

A

Health insurance plan that helps pay medical expenses not covered by Medicare.

19
Q

Work Compensation

A

A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment.

20
Q

TRICARE or CHAMPUS

A

Provide healthcare for active & retired military personnel and their families.

21
Q

Fee-for-service Compensation

A

Plan in which doctors/providers are paid for each service they render.

22
Q

Dependents

A

Family members allowed to be included on an insurance plan.

23
Q

Premium

A

Fee that an individual pays for insurance coverage.

24
Q

Co-insurance

A

Requires that specific percentages of expenses are shared by the patient & insurance company.

25
Q

Deductible

A

An amount that must be paid by the patients for medical services before the policy begins to pay.

26
Q

Co-payment

A

A specific amount of money a patients pays for particular service.

27
Q

Employer-Sponsored Health Insurance

A

Most people have insurance through their place of employment.

28
Q

HMO stand for

A

Health Maintenance Organization

29
Q

HMO

A

A medical insurance that provides health services for a fixed monthly fee.

30
Q

PPO stand for

A

Preferred Provider Organization

31
Q

PPO

A
  • Contract with certain agencies (hospital/doctors) to provide health care reduced rates.
  • Restricted to using a specific hospital & doctors
32
Q

Medicare Part A

A

A health insurance that pays for hospitalization, care in a skilled nursing facility, home health care, and hospital care.

33
Q

Medicare Part B

A

A medical insurance that covers outpatient treatment (e.g., lab testing, doctor appointment).

34
Q

Medicare Part C

A

An additional insurance option, which covers Medicare Part A & B.

35
Q

Medicare Part D

A

Provides prescription drug coverage.

36
Q

CHAMPVA stand for

A

Civilian Health and Medical Program of the Department of Veterans Affairs.

37
Q

CHAMPVA

A

Covers the families of vets who were killed or permanently disabled in the line of duty, who are ineligible for TRICARE.

38
Q

CHAMPUS stand for

A

Civilian Health and Medical Program of the Uniformed Services