Thriteenth Test Flashcards
Hospital insurance began in
1929
Medicare and Medicaid were enacted in
1965
In 2010 the health insurance exchange debated as a part of the Patient
Protect and affordable care act
The person who owns an insurance policy is called the
Member, subscriber insured or policy holder
Those covered by government insurance programs aer known
as beneficiary
Dependents are Family members also covered on
commercial insurance plans.
List three common types of out-of-pocket expenses.
Deductible
Copay
Coin insurance
List the groups of people eligible for government health insurance.
Older adults
Disabled
Military personnel
retired
Medicare part B covers what
phusician care, therapy, and
testing, and members must pay
-based premiums because Part b is a voluntary program.
Medicare Part C is known as the _medicate choice
and si often sold by
private insurance companies offering all parts of Medicare
Medciare Part D covers _
prescription drugs through private companies contracted with Medicare
Medicaid covers
low income patients
TRICARE provides health insurance benefits to family’s of
current and retired military personnel
workers compensation insurance covers workers who have been
injured in the work place or as a result of a work related illness
Disability income insurance is either
Short term or long term
The Family medical leave Act allows employees to take
unpaid leave for specified family and medical reasons, while protecting their jobs
The national prouder Identifer is a
unique, 10 digit number assigned to health care providers by CMS.
The CMS-1500 form is printed in a specific color of _
Red ink so that it is recognizable by OCR scanners.
Insurance companies may accept claims for as long as up to
one year from the date of service or for as little as _90 days
Diagnosis
codes identify the reasons that health care services were provided.
Procedure
codes describe services performed for patient
Physicians
are responsible for coding and billing for all the services the personally provide 4 The Medical Assistant’
The MAs’ role regarding coding involves the following.
assisting communication between physicians and coders when a question arises
The Bertilon Classification of Causes of Death was adopted in
1098 by the American Public Health Association (APHA).
The patient protection and Affordable care act mandates
compliance programs for providers who contract
with Medicare and Medicaid.
Thsi is an alphabetically sequenced list of diagnostic codes divided into
21 chapters based on the cause of the cause or etiology and body system
Verify the code(s) in the
Tabular List
List the three tabulated levels within the sections.
Category three character entries
Subcategory Four- and five-character entries)
the most specific entry that requires no additional characters)
ICD-10-CM codes can be between
Three and seven characters in length.
CPT stands for
Current procedural Terminology.
The first edition of the CPT was published ni
1966 in the American Medical Association, and codes were four numbers long.
The second edition of the CPT published in
1970 expanded Surgical procedures.
The fourth edition, which si used today, was published in
1977
Only one code is
correct in any given situation.
upcoding Is billing
for a higher level of service than was actually provided in order ot gain higher reimbursement.
downcoding is coding for
a lower level of service than was actually provided.
Examples of abuse
Charging excesively high fees for Services or SUPPlies
The C M S website offers information to consumers and patients
to encourage them to identify and _report fraud
The tabular list si a(
Numerical listing of al CPT codes, divided into threw categories
Appendix A
Modifiers
Apendxi B:
Summary of Additions
Appendix C:
Clinical examples
The surgical section is the
largest section in the CPT manual.
Immunizations require 2 codes
one of that _administering of the immunization and one for the particular. Vaccine or toxin
E&M codes begin with the numbers
99
List five services billed in addition to the E&M code.
Venipuncture
Immunization
ECGS EKG
ab test performed in office.
X-rays
