Insurance
Name 4 major types of insurance plans
HMO, PPO, EPO, POS, RPPO, Indemnity, etc.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act.
What does it mean when a claim is returned by the clearinghouse?
Claim is rejected
What does CMS stand for?
Centers of Medicare and Medicaid
Where are our 2 offices located?
Conroe and Waxahachie
What is the term used for the individual responsible for insurance premiums?
Gaurantor
NPI - Must give full name and definition
National Provider Identifier (NPI) - Unique 10-digit identifier assigned to all healthcare providers.
What is a Claims Scrubber?
Checks claims for errors before submission.
Medicare automatically forwards claims to whatever secondary insurance the patient has on file. What is this called?
Crossover
What is the name of our CFO?
Thao Ho
Name the 3 most common government payers.
Medicare, Medicaid, and Tricare.
What does ICD-10-CM stand for and what do we use it for?
International Classification of Diseases, Tenth Revision, Clinical Modification
Used to report diagnoses on claim
What claim form is used to report professional services performed by providers and Ambulatory Surgical Centers (ASCs)?
CMS-1500
Who is the MAC over our region?
Novitas
How many mid level providers do we have?
20
What year was ICD-10-CM implemented in the US?
2015
What is the Medicare QMB program?
Qualified Medicare Beneficiary - Program for patients enrolled in both Medicare and Medicaid who qualify for assistance on part A and B premium payments, deductibles, and coinsurance.
What is the first step in the revenue cycle?
Patient Registration/Data Entry
What are the 4 parts to Medicare and what does each one represent?
A - Hospital
B - Medical
C - Medicare Advantage
D - Prescription Drug
What year was TC2U founded?
May 2017
What are G codes used to describe in the HCPCS Level II code book?
Used to describe procedures/professional services that do not have a CPT code.
Define Modifier 25 and give one example that it would be used for.
Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service.
Name 2 of the 5 ways claims can be submitted to the payer electronically.
DSL (Digital Subscriber Line)
Extranet
Internet
Magnetic Tape, Disc, or Compact Disc
Electronic Data Interchange (EDI)
What year was Medicare signed into law?
Bonus question - by which president?
1965
Lyndon B. Johnson
What is the TC2U Mission Statement?
“To Care and Nurture Seniors, One Patient, One Home, One Family, One Community at a Time.”