Office Financial Management, Billing & Insurance Flashcards
Bookkeeping
Record of financial transactions.
What are the 5 types of transactions?
1) Asset - resources
2) Liability - debts
3) Income - revenue
4) Expense - purchases
5) Equity - earnings
Double-entry Bookkeeping
Every transaction effects 2 accounts by increasing one & decreasing the other.
Fee Schedule
A complete listing of fees that are used to pay doctors or other providers/suppliers
Resources-based Relative Value Scale
RSBRVS
A payment system that is used to calculate medical payments for physician services by the CMS.
Diagnosis-Related Groups
DRGs
CMS pays for inpatient care based on principle diagnosis, age, and other complicating issues.
Contracted Fees
A benefit plan that prohibits extra billing.
What does CMS stand for?
Centers for Medicare & Medicaid Services
ICD-10-CM stand for
International Classification of Diseases, 10th Revisions, Clinical Modification.
HCPCS stand for
Health Common Procedure Coding System
CPT stand for
Current Procedural Terminology
Purpose of HCPCS
Used to fill claims for equipment, supplies and services that are not covered by CPT codes.
What is CPT?
A primary code system used to describe the treatment services provided for that diagnosis.
HCPCS Level 1
Identical to CPT codes, b/t when used bill Medicare/Medicaid it will used HCPCS codes.
HCPCS Level 2
Designed to represent non-physician services & supplies (e.g., ambulance) that aren’t covered by HCPCS Level 1.
Who’s eligible for Medicare?
1) 65+ year old
2) Disability person who has received Social Security benefits for 2 years.
2) Anyone with End Stage Renal Disease (ESRD)
Who’s eligible for Medicaid?
1) Low-income persons
2) Children who qualify for public assistance.
3) Disability
Medigap Policy
Health insurance plan that helps pay medical expenses not covered by Medicare.
Work Compensation
A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment.
TRICARE or CHAMPUS
Provide healthcare for active & retired military personnel and their families.
Fee-for-service Compensation
Plan in which doctors/providers are paid for each service they render.
Dependents
Family members allowed to be included on an insurance plan.
Premium
Fee that an individual pays for insurance coverage.
Co-insurance
Requires that specific percentages of expenses are shared by the patient & insurance company.
Deductible
An amount that must be paid by the patients for medical services before the policy begins to pay.
Co-payment
A specific amount of money a patients pays for particular service.
Employer-Sponsored Health Insurance
Most people have insurance through their place of employment.
HMO stand for
Health Maintenance Organization
HMO
A medical insurance that provides health services for a fixed monthly fee.
PPO stand for
Preferred Provider Organization
PPO
- Contract with certain agencies (hospital/doctors) to provide health care reduced rates.
- Restricted to using a specific hospital & doctors
Medicare Part A
A health insurance that pays for hospitalization, care in a skilled nursing facility, home health care, and hospital care.
Medicare Part B
A medical insurance that covers outpatient treatment (e.g., lab testing, doctor appointment).
Medicare Part C
An additional insurance option, which covers Medicare Part A & B.
Medicare Part D
Provides prescription drug coverage.
CHAMPVA stand for
Civilian Health and Medical Program of the Department of Veterans Affairs.
CHAMPVA
Covers the families of vets who were killed or permanently disabled in the line of duty, who are ineligible for TRICARE.
CHAMPUS stand for
Civilian Health and Medical Program of the Uniformed Services
