Billing 101
The standard of securing the confidentiality of healthcare information was established by the enactment of
What HIPAA
A request for review of an insurance claim that has been underpaid
What is an appeal
The reason a patient is being seen
What is the chief complaint
This is how most payers submit payment to Providers
What is an EFT
Patient returns to the OR within the global period of a previous procedure for a staged procedure.
What is -58 modifier
What is timely filing
This form is used to mail paper outpatient claims to an Insurance company for payment
What is CMS-1500
The patient come in once a year for the ________, paid for by Medicare.
What is the Annual Wellness Visit
A patient will receive this, after the insurance pays a claim.
What is an EOB
Patient is seen in the office for refill of his diabetes medication but complains of right shoulder pain. The provider orders an x-ray of the right shoulder.
What is -modifier 25
Preferred provider plans (PPOs), health maintenance plans (HMOs), and point of service plans (POSs) are considered this type of Insurance?
What is Commercial
A review of a patient's case by one or more physicians to evaluate another physician
What is peer review
Insurance require this for certain procedures
What is an Authorization
You receive this, instead of a paper EOB.
What is ERA (electronic remittance advice)
A NP in Florida is acting as assistant surgeon during a surgery
What is -modifier 80
The ______ book contains all the procedure codes as determined by the American Medical Association (AMA) and includes the definition of each procedure.
What is CPT
A report you run that tells you which claims are outstanding by how old they are, aka over 30, over 60, over 90, over 120
What is an aging report
A patients PCP generates this, when a patient needs to be seen by a specialists
What is a referral
To receive payment at a contracted rate, the physician must be credential as ______
What is in-network
CLIA waived test is billed by the physician
What is- modifier QW
This organization develops, maintains, and owns the copyright to CPT codes, and determines what the code represents.
Who is AMA (American Medical Association)
Claim that is held in a pended state because of an error or need for more information
What is a suspended claim
_____________ must be documented by the provider to perform a procedure/surgery.
What is medical necessity
The process of enrolling a provider with insurances
What is credentialing
A patient has a bilateral knee joint injection
What is modifier-50