CPT
Current Procedural Terminology
What does CPT stand for? / What is CPT?
What does ICD-10-CM stand for?
International Classification of disease 10th edition/revision clinical modification
Approval signature on the reverse side of a check that indicates liability for payment of funds disbursed in the case of default or nonpayment
Endorsement
The life of patient accounts from creation to payment.
The revenue cycle
A contract between a policy holder, and an insurance carrier, or a government program developed to reimburse the policyholder of all or most medical expenses.
Health Insurance
Require 3 things when coding:
1. History
2. Exam
3. Med. Decision Making
Evaluation and Management codes
Coexisting medical conditions
Comorbidity
Paychecks, government checks, and insurance checks made out to one party (e.g., the patient) and fully endorsed over to the physician.
Third-Party Checks
“as much as he deserves”
What is Quantum Merit
Health insurance provided for retired military personnel, active military personnel, and dependents of both
Tricare
Add on codes are represented by what symbol?
+
Plus symbol
Matching up the procedure code with the diagnostic code
Code Linkage
Fees for services rendered and payments are recorded every day on what?
General Ledger
A method based on individual physician charge profiles and customary charge screens.
U.C.R
Usual, customary, reasonable
This prevents nonduplication of benefits if insured has more than one policy
Also prevents duplication of benefits for same medical expense
Coordination of Benefits (COB)
Operation, certain types of anesthesia and normal uncomplicated post-op care with designated follow up days.
Impression made by a physician using the terms rule-out, suspected, suspicion of, questionable, likely, probably, or possible
Qualified Diagnosis
An accurate system that uses a “write-it-once” process for recording daily office transactions.
Pegboard Accounting System
When using what system, a higher number of units are assigned to services requiring greater resources and, therefore, a higher fee.
RVS
Relative Value Studies
What determines the primary insurance plan when a child is covered by both parents?
The Birthday Rule
Name the codebook used for complementary and alternative medicine.
Alternative Billing Coding Manual for Integrative Healthcare (ABC codebook)
These symbols indicate that additional characters are required.
A dash, a check mark, or a hyphen
Date -> Ref# or CPT Code -> Description -> Charge for description -> >Payments/Adjustments> Balance (new balance PLUS balance forward)
are the steps to do what?
To fill out a ledger card.
This was established in 1946. A patient seeking medical care may have no way of paying for care but do not qualify for state aid. Most metropolitan areas have certain hospitals that have received federal construction grants to enlarge their facilities, in exchange for which they must care for indigents needing medical care.
Hill-Burton Act
Explain The Birthday Rule
Determines primary insurance plan when child covered by both parents
Health plan of parent whose birthday falls earlier in calendar year is primary or
Plan of the parent with custody is primary