Femur
What is covered under Medicare Part D
What is prescription drugs
When an account is in IWO status what does that mean?
What is awaiting insurance adjustment to be posted in Client's System
What is the abbreviation for End Stage Renal Disease
What is ESRD
23/24-hour observation in a hospital/facility
What is a bedded outpatient
What is timely filing for Medicare Part A & B Fee For Service claims
What is 1 year or 365 days from the date of service
An agreement that determines which insurer has primary responsibility for payment an which has secondary responsibility
what is coordination of benefits or COB
When the insurance company changes the code(s) used and reduces the corresponding charges of a claim when there is no documentation to support the level of service submitted by the provider
What is downcoding
The total of all line item charges submitted on UB-04 or HCFA-1500 claim forms
What are technical charges
Hospice is covered under which part of Medicare
What is Part A
this term refers to the process of translating the service rendered to a patient into a standard set of medical codes
what is coding
What is the rule that determines which insurance plan is primary and secondary when a child is covered by both the Mother’s and Father’s insurance plans
What is the birthday rule
Medical services performed on an outpatient basis without admission to a hospital or other facility
What is ambulatory Care
The number assigned by the health insurance company when they accept a claim in their system for review and payment
What is the document control number or DCN
When does the Medicare enrollment process begin?
What is 3 months prior to turning 65 (including the month of your birthday
Medicare coverage for a medical condition in which a person’s kidneys cease functioning on a permanent basis
what is ESRD or End Stage Renal Disease
A level of coding methodology utilized in billing services and/or supplies, drugs and equipment. Level I is identical to CPT codes. Level II is used to identify drugs, supplies and equipment used to treat the patient (Technical Charges). It is used primarily by Medicare and Medicaid, but can also be used by other insurance providers.
What are HCPCS codes
In Original Medicare, these are additional days that Medicare will pay for when a patient is in a hospital for more than 90 days. The use of these days must be approved by the beneficiary prior to use. A total of 60 days is available to use during a patient's lifetime and are not replaced once used are known as
What is lifetime reserve days
Who can qualify for Medicaid?
What is:
Set of five-digit codes for billing and authorization of evaluation and management services broken down into groupings
Current Procedural Terminology Codes (CPT)
The dollar amount above the insurance company’s allowed amount for the submitted charges
What is a contractual obligation/adjustment/write-off
Which two sets of codes describe the patient’s medical condition on the claim
What are CPT and HCPCS codes
In Latitude what comes over in a placement file?
What is patient/ guarantor demographics and insurance information
When a claim denies for medical necessity what are some steps to take in resolving the denial?
What is:
1. verifying LCD/NCD policies
2. reviewing medical records
3. reviewing patient's benefit plan
4. calling the carrier to very if the procedure code or dx code is driving the medical necessity denial
What is the purpose of a DRG or Diagnosis Related Group
What is drives the reimbursement of an inpatient claim
what are CO 151 and CO 222