Week 3

Question 1

NPP aka HIPAA form

Answer 1

Notice of privacy practices

Describes how the facility is going to use. Protect your health care info. It has to be displayed at desk.

Question 2

What is always verified at the time an appointment is made?

Answer 2

Insurance (effective date and eligibility), DOB, Full name, benefits under their insurance plan

Question 3

Gatekeeper

Answer 3

The primary care provider (PCP), who is in charge of a patient’s treatment. .

Question 4

What are responsibilities of a gatekeeper

Answer 4

Additional treatment, such as referrals to a specialist, must be approved by the gatekeeper

Question 5

Who pays after Medicaid?

Answer 5

State and federal government, after Medicaid, the remaining cost of the bill is written off. (AKA NOBODY PAYS)

Question 6

What are other managed healthcare plans besides Hmo?

Answer 6

A preferred provider organization (PPO) & An exclusive provider organization (EPO)

Question 7

Health insurance exchange

Answer 7

An online marketplace where you can compare and buy individual health insurance plans. State health insurance exchanges were established as part of the Affordable Care Act.

Question 8

What are QMB’s?

Answer 8

Qualified Medicare beneficiaries (QMBs) Low-income Medicare patients who qualify for Medicaid for their secondary insurance.

Question 9

Long term care insurance

Answer 9

is a relatively new type of insurance that covers a broad range of maintenance and health services for chronically ill, disabled, or developmentally delayed individuals. Medical services may be provided on an inpatient basis (e.g., at a rehabilitation facility, nursing home, or mental hospital), on an outpatient basis, or at home.

Question 10

Precertification

Answer 10

The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure or service. A notification is sent to the payer (e.g., insurance provider) regarding the service or treatment. The payer then responses indicating if the service is covered under the plan. (How much they are going to pay)

Question 11

Preauthorization

Answer 11

A process that requires the provider to submit documentation to the payer to show the service or treatment is medically needed and the payer determines if the service or treatment is medically necessary and covered under the insurance plan. (If they are going to pay the procedure or not)

Question 12

VA health care

Answer 12

The Veterans Health Administration (VHA) is the largest healthcare system in the US. Is for veterans

Question 13

Obama care

Answer 13

New name Affordable Care Act or Healthcare reform!!
It wasn’t really Obama’s healthcare, He was just the president who signed that act but this type of healthcare was being planned before he became president

Question 14

Insurance

Answer 14

Protects against financial loss or harm from specified circumstances

Question 15

Policy

Answer 15

A written agreement between two parties, in which one party (the insurance company) agrees to pay another party (the patient) if certain specified circumstances occur.

Question 16

Premium

Answer 16

The periodic (monthly, quarterly, or annual) payment of a specific sum of money to an insurance company, for which the insurer in return agrees to provide certain benefits. (Keeps inc active)

Question 17

co-insurance

Answer 17

The percentage of costs of a covered healthcare service the policyholder pays after the deductible has been paid. The insurance company pays its portion, and the policyholder pays the remaining amount. A typical split is 80/20 – the insurance company pays 80%, and the policyholder pays 20%.

Question 18

co-pay

Answer 18

A set dollar amount (small fee ) that the policyholder must pay for each office visit.

Question 19

Deductible

Answer 19

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services. (Large amount before the insurance kicks in)

Question 20

Group Policy

Answer 20

A private health insurance plan purchased by an employer. An employer can pick and choose the benefits it wants for employee’s, such as vision or dental coverage.

Question 21

Beneficiary

Answer 21

A designated person who receives funds from an insurance policy.

Question 22

Network

Answer 22

Connection between providers - Designated group

Question 23

Out of network

Answer 23

Go outside of covered choices “Stay in your network”

Question 24

Participating provider

Answer 24

Gov and most private insurance. Provider accepts your insurance.

Question 25

HMO

Answer 25

Health maintenance organization

Health plans that are regulated by HMO laws “managed healthcare” (Cheaper) (Co-pay) They have limited choices and limited flexibility

Question 26

Capitation

Answer 26

A way of paying health care providers or organizations in which they receive a predictable, upfront, set amount of money to cover the predicted cost of all or some of the health care services for a specific patient over a certain period of time.

Question 27

U codes

Answer 27

New conditions/diseases

Question 28

Z codes

Answer 28

Prophylactic/ preventative care

Question 29

code HIV

Answer 29

This indicates only that the virus is present (Has nothing to do with AIDS)

Question 30

NOS

Answer 30

Not otherwise specified (Unspecified)

Question 31

if no DX, then code

Answer 31

signs & symptoms

Question 32

Abstract

Answer 32

To collect important information from the health record.

Question 33

Sequela

Answer 33

An abnormal condition resulting from a previous disease. (after effects, effects that happen after you had the disease has gone away)

Question 34

Essential modifiers

Answer 34

These terms are indented under the main term. They can modify the main term by describing different sites or etiology. They must be included in the diagnostic statement. (change code to be more specific)

Question 35

What is place holder X?

Answer 35

is used to fill the empty character spaces.

Question 36

Burns are coded by:

Answer 36

They are coded by the site where they are, the degree, and the body surface involved

Question 37

Carcinoma

Answer 37

Tumor of Cancer

Question 38

Benign

Answer 38

The growth is noncancerous, nonmalignant, and has not invaded adjacent structures or spread to distant sites. (GOOD, NO CANCER)

Question 39

Malignant

Answer 39

The growth is cancerous, and malignant, and has invaded adjacent structures or spread to distant sites. (BAD, CANCER)

Question 40

Carcinoma in situ

Answer 40

is defined as situated in the original place or position. Tumor cells are undergoing malignant changes but are still confined to the point of origin, without invasion of surrounding normal tissue. The Ca in situ column is used only if the provider documents that precise terminology. (Cancer that stays in one place, doesn’t spread)

Question 41

Primary site

Answer 41

The original site where the cancer started

Question 42

Post-partum

Question 43

DO NOT IGNORE “CODE FIRST”

Question 44

Encounter form

Answer 44

Document where the doctor and you document what you both did. Doctors put the code.

Question 45

H & P

Answer 45

History and Physical

Question 46

ICD-10-CM

Answer 46

International Classification of Diseases, Tenth Revision, Clinical Modification