Study Guide Flashcards
Although eligibility for medicare part B is automatic for people entitled to medicare part A
Part B coverage is not automatic
A colon is used in the tabular list after an incomplete term that needs one of the terms that follows
The colon to make it assignable to a given category
In the alphabetic index, the word see refers you to
A different main term for the condition
Leaning back in a chair or away from a person and folding your arms across your chest is a
Closed posture that may convey to patients that you are not totally receptive to what they are saying
The insurance claim would be denied as a billing error because the treatment was not
Medically necessary based on the diagnosis code and there’s no evidence of code linkage
Workers of any age who have chronic kidney disease requiring dialysis or end stage renal disease (ESRD) requiring transplant are eligible for
Medicare
Liability insurance covers
Injuries caused by the insured or that occurred on the insurance property
Parentheses are used in both ICD - 9 and ICD - 10 around descriptions and alphabetic index that
Do not affect the code that is, those that are non essential or supplementary terms that may assist you in choosing the correct code
Medicaid is a health cost assistance program designed for
Low income, blind, or disabled patients it is not an insurance program
“Excludes” indicates that an entry is not classified as part of the proceeding code and may also
Give the correct location of the excluded condition to help you find the correct code
The ICD code are updated
Every year on October 1st
The source sends the message to a receiver (1)
The receiver is missing in this figure
It is fraudulent for people to
Misrepresent their credentials
Code linkage is the analysis of the connection between The diagnostic and procedural information on a claim and is done by
Insurance companies to evaluate the medical necessity of the reported charges
Billing for a moderate level evaluation and management service went only a minimal exam BP check and injection were performed is an example of
Reporting services at a higher level than was carried out
During communication, posture can usually be described as
Open (receptive or friendly) or closed (unreceptive angry)
Billing separately for items that are bundled in a single procedure code is referred to as
Unbundling
A friendly but professional approach, a pleasant greeting, and a smile are
Interpersonal skills that help a patient feel relaxed
Fraud is an act of deception used to
Take advantage of another person or entity
Medicare part a is
A hospital benefit for patients who are admitted as in patients for up to the 90 day benefit period
The alphabetic index contains
And alphabetic listing of diagnosis descriptions
The diseases, conditions, and injuries in the tabular list are
Organized into chapters according to the source or body system
Therese says she’s OK with having surgery, but her closed posture, avoidance of eye contact, and facial expression imply that
She may not mean what she says
A friendly but professional approach, a pleasant greeting, and a smile are
Interpersonal skills that help a patient feel relaxed
After receiving the message from the source
The receiver sends feedback to the source
Never allow yourself to make Value judgments or
Stereotype a patient, culture, or ethnic group
To avoid the risk of fraud, medical offices have a compliance plan to
Uncover compliance problems and correct them
Forgetting common courtesy’s, such as saying please and thank you, is a form of
Negative communication
When a compliance plan is in place, in demonstrates To payers like medicare that
Honest on going attempts have been made to find and fix weak areas of compliance with regulations
In a typical medical practice, claims are transmitted within
A few business days after the date of service
Procedures that are not related to the patient’s current condition are considered
Not medically necessary
HCPCS was originally developed by the centers for medicare and medicaid services for use in
Coding services for medicare patients such as durable medical equipment (DME)
In the review for allowable benefits, the claims department compares the fees the physician has charged with
The benefits provided by the patient’s health insurance policy to determine the amount of deductible or coinsurance patient owes
A copayment is
A small fixed fee collected at the time of The Visit from patients who belong to a managed care health plan
It is considered unethical and fraudulent to intentionally
Unbundle procedures into compartment codes when a bundle procedure code is available
The brace encloses a series of terms, each of which is modified by
The statement that appears to the right of the brace
Brackets are used around
Synonyms, alternative wordings, or explanations in ICD - 9 - CM
Body language is an example of
Non verbal communication
The total amount the patient owes the practice, including coinsurance, copayment, deductible, and non covered services is known as
Patient liability
The entries following the term “includes” further define
The content of a preceding entry
