Insurance Terms
What you pay when you go for just an office visit.
Co-pay
What does ICD mean?
International Classification of Diseases
What is an EOB?
Explanation of Benefits- Shows what insurance paid to the doctor
What does CPT mean?
Current Procedural Technology
A filing system in which the most recent files (by date) are inserted so they are on top of documents with earlier dates in the file folder.
reverse chronological order
What you pay in order to have insurance.
Premium
What is an ICD code for.
Identifying a diagnosis.
A procedure the insurance does not think is medically necessary is called what?
elective
What is unbundling? Is it good practie?
Use of several Current Procedural Terminology codes for a service when one inclusive code is available.
No it is not. Can be considered fraud.
For some procedures you have to have _________ before the procedure in order for insurance to pay.
Pre-certification
How many types of Medicare are there?
4- Medicare A, Medicare B, Medicare C, Medicare D
Who sets the ICD codes?
World Health Organization (WHO)
If a patient is covered by their insurance and their spouses insurance how do determine which insurance to bill first?
By using the birth date rule. The person who has the first birthday in the year is primary.
One or more 2-digit codes assigned to the 5-digit main code to show that some special circumstance applied to the service or procedure that the physician performed.
modifier
A reminder file for keeping track of time-sensitive obligations.
Tickler File
What is it called when you still have a percentage to pay after your deductible is met?
Co-Insurance
How many classifications of ICD codes are there?
21
This is the form you fill out to file a claim
CMS-1500
The connection between diagnosis code and procedural codes is called_____.
Code linkage
A schedule that details how long to keep different types of patient records in the office after they have become inactive or closed and how long the records should be stored.
retention schedule
What are the 4 types of Medicare for?
A- Hospitalization
B- Doctor's visits and routine health costs
C- Medicare Advantage plans or supplemental coverage
D- Prescription coverage
What are the two types of indexes or lists that ICD-10 code are found through?
Alphabetic Index and Tabular List
This is what Meidcare uses to base their pay outs on, depending on costs of resources and not what the provider wants to bill. Uses geographic location to help determine amount paid.
Resource-based Relative Value Scale (RBRVS)
What three factors are used when determining level of service to bill?
1. Extent of history taken.
2. Extent of exam conducted.
3. Complexity of medical decision making.
This states that there must be "reasonable safguards" in place to protect PHI from any disclosure whether intentional or unintentional.
HIPAA