Stuff We Should Know
IS BILLED FIRST WHEN MORE THAN ONE MEDICAL PLAN CAN BE BILLED.
THE PRIMARY PAYOR
COB
Coordination of Benefits
Injured on the job
Workers Comp
What is Tricare?
Insurance for military dependents and retired military
a medical code set developed by the World Health Organization classifies diagnoses and symptoms?
ICD
Any information in a medical record that can be used to identify an individual
Personal Health Information (PHI)
DOS
Date of Service
USED ON THE CLAIM FORM FOR A PATIENT WHO UNDERWENT BILATERAL ATHRODESIS, KNEES
MODIFIER 50
What does Medicare part B cover?
Outpatient services
the act of collecting patient balances?
Patient collections
Heath Maintenance Organizations require this?
Primary Care Physicians or PCP
RA
Remittance Advice
OFFICE, HOME, BIRTHING CENTER, HOSPITAL, NURSING FACILITY
PLACES OF SERVICE (POS)
BEFORE the appointment, what three things should the Biller verify?
Eligibility
Benefits
Effective date of insurance
the allocate funds to the balance due of an account?
Post Payment
a two-character code added to a CPT OR HCPCS code that provides further information about the procedure?
Modifier
1500
The organization used to "scrub" a claim to check for errors and then electronically transmit claim information
Clearinghouse
Why should the ICD and CPT or HCPCS code match?
To prove medical necessity
Also known as superbill, charge ticket, or visit/fee slip; contains all of he information insurance companies require in order to consider a claim for payment?
Encounter Form
A medical code set maintained by the American Medical Association. Each code identifies a medical, surgical, or diagnostic procedure or service performed?
CPT
NPI
National Provider Identifier
What does Medicaid Part A cover?
Inpatient services
A notice given to patients to indicate that Medicare is not likely to pay for a specific service and the patient would be responsible for those charges
Advance Beneficiary Notice (ABN)
the classification of accounts by the time elapsed after the date of billing or the due date?
Aging