Medical Billing & Coding: Final Exam Study Guide,2024-2025., Exams of Medicine

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Medical Billing & Coding: Final Exam Study

Guide,2024-2025.

Medicare - ANSThe largest federal program providing healthcare is __________________ which provides health insurance for citizens aged 65 and older as well as certain patients under the age of 65. Medical Assistant - ANSThe ___________________ ______________ is responsible for filing insurance claims in most medical offices.. Assignment, Benefits - ANSPatients are generally asked to sign an _____________ of _____________statement, in which the provider agrees to prepare healthcare claims for patients, receive payments directly from the payers, and accept a payer's allowed charge. Policyholder - ANSThe ______________ may be called the insured, the member, or the subscriber. Premium, an annual charge - ANSUnder an insurance policy, the policyholder pays a __________ or _________________________ for keeping the insurance policy in force. Deductible - ANSA ___________________ is a fixed dollar amount that must be paid or "met" once a year, in addition to the premium, before the third-party payer begins to cover medical expenses. Co-payment - ANSA ____________________ is a small, fixed fee collected at the time of the visit from the patients who belong to a managed care health plan. After - ANSIn a typical medical practice, claims are transmitted within a few business days ____________ the date of service. Diagnosis code - ANSInsurance claims could be denied as a billing error because if the treatment was not medically necessary based on the ____________________ and there is no evidence of code linkage. Review, Allowable - ANSIn the ____________ for ___________ 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 the patient owes. liability - ANSThe total amount the patient owes the practice, including coinsurance, copayment, deductible, and noncovered services, is known as the patients __________________.

Liability - ANS_____________________ insurance covers injuries caused by the insured or that occurred on the insured's property. Automatic - ANSAlthough eligibility for Medicare Part B is automatic for people entitled to Medicare Part B coverage is not ______________________. hospital - ANSMedicare Part A is a _______________ benefit for patients who are admitted as inpatients for up to the 90-day benefit period. 60 - ANSA Medicare benefit period begins the day a patient is admitted to the hospital and ends when that patient has not been hospitalized or placed in a skilled nursing facility for a period of ________ continuous days after discharge. assistance, insurance - ANSMedicaid is a health cost _________________ program designed for low-income, blind, or disabled patients. It is not an ______________ program. Medicare - ANSWorkers of any age who have chronic kidney disease requiring dialysis or end-stage renal disease (ESRD) requiring transplant are eligible for ________________. Respite - ANS____________ is a short break provided for caregivers to terminally ill patients. The patient is moved to a respite care center or other facility to remove responsibility for care from the caregiver temporarily. Hospice - ANS____________ programs provide pallitative care, including pain relief and support for terminal patients and their family members. Medicare(3) - ANS___________ is responsible for paying 80% of the allowed charges after the patient has met the annual deductible, as patients typically have an 80- coinsurance. RBRVS (Resource based Relative Value Scale) - ANSMedigap is not a part of Medicare's _______________________________________________. Inferior - ANSPeople who qualify for Medicaid assistance are in no way _____________ to those with private insurance. 65, Military - ANSTRICARE for Life enrollees who are aged ______ and older can receive healthcare at a ____________ treatment facility BlueCross, BlueShield - ANS_____________________ and ________________ is a nationwide federation of nonprofit and for-profit service organization that provide prepaid healthcare services to subscribers.

total - ANSIn most states, Workers Compensation includes coverage of ____________ costs to restore an employee's ability to work. Electronic - ANS__________________ claim submissions are cost-efficient even in smaller offices, and claims are generally paid much more quickly- within a week or two instead of 6 to 8 weeks for paper claims. first - ANSThe birthday rule states that the insurance policy of the policyholder whose birthday comes _____________ in the calendar year is the primary payer for all dependents. data elements - ANSThe information entered on electronic claims is called __________________ _______________. The clearinghouse must receive all of the necessary data elements from the medical office before it can submit a claim. Claims - ANS_________________ are prepared for electronic submission after all of the required data elements have been posted to the medical billing software program. 90 - ANSChange your password every _______ days or as directed by facility policy. TRICARE, CHAMPVA - ANS_____________ and _____________ provide healthcare benefits to families of current military personnel, retired military personnel, and veterans. Medicare (4) - ANS___________________ uses a resource-based relative value scale to determine the fees they pay for services rendered. Capital - ANSEnter all data into the medical billing program using __________ letters. Predetermination - ANS__________________ is the process in which the insurance plan informs the physician of the maximum amount they will pay for the procedure to be performed. Preauthorization - ANS__________________ is the process of contacting the insurance plan to see if the proposed procedure is a covered service under the patient's insurance plan. previous - ANSEligibility for Medicaid is based on how much income and assets the patient reported for the ____________ month. policy number - ANSThe patient's personal health insurance _______________ _______________ is not needed for workers' compensation claim. birthday - ANSThe _____________ rule states if a husband and wife both have insurance through their employers, the insurance policy of the policyholder whose birthday occurs first in the calendar year is the primary payer for all dependents.

fee schedule - ANSA medical office's ________ _________ are the fees charged to most of their patients most of the time under typical conditions. taxonomy code - ANSThe _______________________ is a 10-digit number that represents the physician's medical specialty. before - ANSThe ABN, or Advance Beneficiary Notice of Noncoverage, must be verbally reviewed with the beneficiary or his or her representative and any questions raised during that review must be answered ________________ it is signed. Underpayment - ANS______________________ can occur when healthcare providers submit claims for a simple procedure, but the medical record reveals that a more complicated procedure was actually performed. every - ANSYou should contact Medicaid to verify patient's benefit eligibility ___________ time they are seen in the office. 80-20 - ANSWith an _____ - _____ coinsurance, your patient will be responsible for 20% off the allowable charge; or 20% of $100, which is $20. copayment - ANSA _______________ is a small fee paid by the patient that is collected at the time of the visit. references - ANSCompanies have manuals for _______________ and representatives of the insurance companies are available to answer _______________ about a patient's coverage. Medical - ANSUnless the patient has a ___________ emergency, Medicaid often requires authorization before services are performed. A, B - ANSMedicare part _____ is hospital insurance and Part ____ helps pay for a wide range of procedures and supplies. this date - ANSThe effective date of insurance coverage should always be verified. Services performed before ___________________ may be excluded from claims. October 1, 2014 - ANSUnder HIPAA, the diagnosis code that must be used in the United States started on _____________________. 3 to 7 - ANSICD-10-CM s a ______ to ______ character alphaneumeric representation of a disease or condition. category - ANSA ____________ code in ICD-10-CM is three characters. subcategory - ANSA _______________ code in ICD-10-CM has four to five characters.

final code - ANSA ___________ in ICD-10-CM has six to seven characters. disease, injuries - ANSPart of ICD-10-CM list _____________ and _____________ alphabetically with corresponding diagnosis codes. tabular - ANSThe _________ list is made up of twenty-one chapters of disease descriptions and their codes. alphabetical index - ANSThe ICD-10-CM index to Disease and Injuries is known as the __________________ ______________. diagnostic - ANSA ______________ statement is a physician's description of the main reason for a patient's encounter. alphabetical, tabular - ANSWhen coding, the coder first locates the description/code in the _______________ index and then verifies the proposed code selection by turning to the ______________ index and studying the entries. hyphen - ANSThe _____________ means that the coder will need to drill down to select the right code. main - ANSEach __________ term appears in boldface type and identifies a disease or condition. default - ANSEach main term appears in boldface type and is followed by its _________ code. Subterm - ANSA ______________ is a word or phrase that describes a main term in the Alphabetic Index. Non-essential - ANS______________ modifiers for main terms or subterms are shown in the parenthesis on the same line. etiology - ANSThe cause or origin of a disease or condition is called the ______________. eponym - ANSAn _______________ is a condition (or procedure) named for a person or patient. name, main - ANSAn eponym is usually listed both under the ________ an under the _________ term (disease or syndrome) manifestations - ANSWhen dealing with syndromes, if the syndrome is not identified, its ___________________ are assigned codes.

turnover - ANSIf the main term or subterm is too long to fit on one line, as is often the case when many non-essential modifiers appear, _____________ lines are used. "see" - ANSThe coder must look up the term that follows the word _________ in the index. "see also" - ANSThe _________________ category indicates that the coder should review the additional categories that are mentioned. Not Elsewhere Classified - ANS______________________________________ appears with a term when there is no code that is specific for the condition. " a condition is not described enough" - ANSNot otherwise specified means ____________________________________________________________________. Combination - ANS_____________________ code is a single code that describes both the etiology and manifestation of a particular condition. two, complication - ANSCombination codes that classify __________ diagnoses or a diagnosis with an associated ______________________ may also exist. "X" - ANSCharacter "______" is inserted in a code to fill a blank space. sequence, visit - ANSThe seventh character in some categories specifies the ___________ of the ______________. 7 - ANSThe seventh character must always be in position ______ and you use a placeholder character ("x") to fill the empty space. 3, 4, 5, 6, 7 - ANSThe smallest division of a code has either _______, _________, __________, ________, or ________ alphanumeric characters. letter - ANSThe first character is always a ___________. "u" - ANSThe complete alphabet except for the letter "______" is used. 1 - ANSExcludes ____ is used when two conditions could not exist together. 2 - ANSExcludes ____ means a patient could have been conditions at the same time. Parenthesis - ANS_______________ are used around descriptions that do not affect the code. laterality - ANSUse of ICD-10-CM classification system to capture the side of the body that is documented in the concept of ___________________.

code first underlined - ANSThe instruction _________________________________ disease must not be used as a first listed diagnosis. additional - ANSThe order of codes must be the same in the Alphabetic Index when the instruction "use ____________________________ code" is noted. Unspecified - ANSWhen the affected side of the condition is not known, an ____________________ code is assigned. Chief Complaint - ANSCC stands for ________________________________. Chief complaint - ANSThe patient's _______________________________ describes the reason they are seeking medical care at this time. accident - ANSThe main term in the diagnostic statement "cerebrovascular accident" is ______________________. modifiers - ANSThe appropriate use of _______________ with CPT codes can greatly enhance your reimbursement and can cut down on claim inquiries from the insurance carrier. front - ANSThe evaluation and management (E/M) codes are used so frequently that they are placed in the ____________ of the CPT manual for easy reference. new - ANSThe general rule of thumb is that if a patient has not been seen in the practice within three years, he or she is considered a _____________ patient. fraudulant - ANSIt is considered unethical and ___________________ to intentionally unbundle procedures into component codes when a bundled procedure code is available. HCPCS - ANS___________________ was originally developed by the Centers for Medicare and Medicaid Services (CMS) for use in coding services for Medicare patients. code link - ANS_________________ _____________ 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. fraud - ANS_________________ is an act of deception used to take advantage of another person or entity. Fraudulant - ANSIt is ________________ for people to misrepresent their credentials. compliance - ANSTo avoid the risk of fraud, medical offices have a ______________ plan to uncover compliance problems and correct them.

find, fix - ANSWhen a compliance plan is in place, it demonstrates to payers like Medicare that honest, ongoing attempts have been made to _________ and ____________ weak areas of compliance with regulations. Unbundling - ANSBilling separately for items that are bundled in a single procedure code is referred to as _____________. not medically - ANSProcedures that are not related to the patient's current condition are considered ______________________ necessary. higher - ANSBilling for a moderate level evaluation and management service when only a minimal exam (BP check) and injection were performed is an example of reporting services at a ______________ level than was carried out. date, services - ANSThe codes to be used are always based on the ___________ of ____________ not the date of claim or the date of the question. add on - ANSA plus sign (+) is used for ________ ________ codes that are used to describe procedures done in addition to a "main" procedure. 52 - ANS_________ is the two-digit modifier that indicates that one or more special circumstance applies to the service or procedure the physician performed. CPT - ANSHCPCS Level I codes are more commonly known as ________ codes. Supplies, durable - ANSHCPCS Level II codes are issued by CMS and cover many _____________, such as sterile trays, drugs, injections, and ________________ medical equipment. Internal Coding Audits - ANS________________ _____________ ____________ or code reviews, are performed to help avoid errors before the claims are submitted. Insurance carriers may order external coding reviews if fraud due to linking errors is suspected. annually - ANSThe CPT manual is updated ______________, and new codes are used for services beginning January 1 of each New Year. introduction - ANSThe _______________ to the CPT manual contains information regarding common prefixes, suffixes, and word roots found within the manual. 5, numeric - ANSCPT codes are __________ -digit ______________ codes. up, semicolon - ANSTo complete the description for a CPT code that has an indented description, read the description of the previous CPT code _______________ to the

__________________; then add the indented description after the semicolon to complete the description. addition - ANSAdd-on codes describe procedures done in ____________ to the main procedure. blue triangle - ANSA ________________ next to a code indicates that the code description has changed since the previous edition of the CPT manual. bulls eye - ANSThe _________-______ symbol denotes moderate (conscious) sedation and means it is understood that conscious sedation is necessary for the procedure performed and so is included in the procedure; it cannot be billed separately. red dot - ANSA _____________ appears next to codes that are new since the previous edition to the CPT. pound - ANSA _________ sign appears next to a code that appears out of numerical sequence. 3-4 - ANSA maximum of _________ modifiers can be assigned to a CPT code. special circumstances - ANSThe use of a modifier shows that one or more ____________________________________ apply to the service or procedure the physician performed. A - ANSThe CPT's Appendix ____ explains the proper use of each modifier. D - ANSAppendix _____ in the CPT manual contains a complete listing of all add-on codes in the manual. tracking, performance - ANSCategory II codes are optional, supplemental ____________________ codes used to track healthcare ___________________ measures, such as programs and counseling to avoid tobacco use or reduce weight. consult - ANSFor a service to be considered a ____________, the 3Rs must be present: request from another physician, record (documentation) of findings and recommendations, and report to the referring physician. Counseling - ANS___________________ is considered part of evaluation and management (E/M) services, but if a complete history and physical exam does not occur, these codes may be used. self limiting - ANSThe common cold is a _______________ _____________ condition that will run its course; afterward, the patient will recover without medical intervention.

head, feet, toes - ANSMusculoskeletal subheadings begin with general, and then start with the ___________ and work their way down to the __________ and ________________. spleen, bone marrow, lymph nodes - ANSThe Hemic/Lymphatic Systems subsection includes procedures on the __________________, _________________, and _________________________. 2 - ANS______ codes are requires for vaccinations. injection, vaccine - ANSOne for giving the ____________, and one for the particular ____________ that is given. E/M, Alphabetical - ANSWhen coding E/M codes, it may be easiest to go directly to the _______ section of the CPT, but for all the other procedures, you will need to use the ______________________ listing of procedures in the back of the CPT manual. code - ANSIf a __________ range is listed next to the description in the index, you should check each code in the range to choose the correct code. Reimbursement - ANSThe use of modifiers can greatly enhance your _________________ and can cut down on claim inquiries from the insurance carrier. Level 2 - ANSHCPCS ______________________ codes have five characters, either numbers, letters, or a combination of both.