Codes
These codes are for medical services and procedures performed by the provider.
(bonus 100pts for defining the acronym)
CPT (Current Procedural Terminology)
UCR fee: $300
Insurance allowed fee: $200
Coinsurance: 20%
Cost of procedure for pt?
$40
UTI
Urinary Tract Infection
New patient
60 min
Information that can be observed or measured.
objective
These codes are for supplies, procedures, and services not described by CPT. (bonus 100pts for defining the acronym)
HCPCS (healthcare Procedure Coding System)
UCR fee: $425
Insurance allowed fee: $250
Coinsurance: 20%
Amount of adjustment?
$175
ACO
Accountable Care Organization
Urgent
20 min
Individual who receives a diagnosis of a serious illness may say, “That can’t be right. I feel fine!” Is in what stage of grief?
Denial / Stage 1
Additional characters added on to a CPT or HCPCS code that provide additional information.
modifiers
UCR fee: $350
Insurance allowed fee: $300
Coinsurance: 30%
Cost of procedure to pt?
$90
EOB
Explanation of benefits
Established/follow-up
15 min
When you answer the phone, what are two essential things to include in your greeting?
Your name & the clinic name
Used for diagnosis for outpatient clinics
(bonus points if you define the acronym)
ICD-10-CM
International Classification of Disease, 10th revision, Clinical Modification
UCR fee: $350
Insurance allowed fee: $250
Copayment: $25
How much does insurance pay?
$225
DME
Durable Medical Equipment
(Bonus points if you know the code set that covers this)
Other entities
30 min
Interaction between a patient and a medical professional focused on improving the physical and emotional well-being of the patient.
therapeutic communication
Diagnosis codes for inpatient facilities
(bonus points if you define the acronym)
ICD-10-PCS (International Classification of Diseases, 10th Revision, Procedure Coding System)
UCR fee: $500
Insurance allowed fee: $450
Coinsurance: 20%
How much does insurance pay?
$360
A/R
Accounts receivable
Complete annual physical exam
60 min
While all health care professionals have a common goal of providing excellent quality care, it is especially important to include _________ communication as a goal in quality care.
adaptive