Study Guide

Question 1

If a patient is charged the difference between what is allowed and what is charged, this is called ________ billing and is allowed for nonparticipating physicians.

Answer 1

Balance

Question 2

The transfer of money from one bank to another is called ________?

Answer 2

EFT - Electronic Funds Transfer

Question 3

ICD codes are assigned to a diagnosis of myocardial infarction. What does myocardial mean?

Answer 3

Heart muscle

Question 4

What regulation addresses outpatient billing for nonphysician providers?

Answer 4

Incident-to billing

Question 5

What task is being performed by the insurance specialist using an insurance aging report for claims more than 30 days old?

Answer 5

Follow up

Question 6

Implementing various aspects of HIPAA is the responsibility of which entity?

Answer 6

CMS

Question 7

To determine a physician’s participating status in a health plan, the physician’s education and license is verified, which is called ________.

Answer 7

Credentialing

Question 8

If the last digit in a diagnosis code indicates that the condition is on the right side, what is being defined by the code?

Answer 8

Laterality

Question 9

What is a map between two different sets of information?

Answer 9

Crosswalk

Question 10

Which physician contracts with the third-party payer and accepts the allowed amount as payment in full?

Answer 10

Participating

Question 11

Which is an example of unbundling codes?

Answer 11

Billing services separately within the surgical package