Cruella De'Ville
CARC is abbreviated for what healthcare term
What term best describes an application process for a provider to participate with an insurance company?
What is credentialing
What term best describes an agreement between health insurers to prevent double payment for the patient's care when more than one plan provides coverage?
What is coordination of benefits or COB
What is DDE abbreviated for?
What is Direct Data Entry
What term best describes when claim information is automatically sent from Medicare to a secondary insurer?
What is a crossover claim
Who can qualify for Medicaid?
What is Low-income families/children, Elderly, pregnant woman, disabled persons
Is the following statement true or false: Prescriptions are covered under Medicare Part C.
What is false
How many form locaters are present on a UB04 claim form
What is 81 form locators
What government plan is jointly funded by both federal and state governments
What is Medicaid
This is a third party company that acts as an intermediary between the provider or hospital/facility and the insurance company. This entity checks claims for errors, also known as scrubbing
What is a clearinghouse
When does the Medicare enrollment process begin?
What is 3 months before, including the month of the person's 65th birthday and 3 months after
DME (Durable Medical Equipment) is covered under what part of Medicare
What is Part B
Hospice is covered under what part of Medicare?
What is Part A
What term best describes the identification of the nature of an illness or other problem by examination of the symptoms?
What is a diagnosis
what set of codes describe what supplies or equipment was used for a service/procedure ?
What are HCPCS codes
Is the following statement true of false: When a Medicaid recipient has a managed care plan they do not have to have a referral from their PCP to see a specialist within their network.
What is False
What is the term that best describes medical services performed on a outpatient basis, without admission to a hospital or other facility
What is ambulatory care
what set of codes describe the service/procedure that was being performed?
What are CPT codes
What is the professional term for hospital/UB04 charges?
What are technical charges
If a person is <65 years of age, under what circumstances can they qualify for Medicare
What are persons with disabilities, ESRD, or Black Lung Disease
What set of codes describe "why" a procedure/service was performed
What are ICD-10 CM codes/ Diagnosis Codes
What set of codes drive the reimbursement on an inpatient claim?
What are DRG codes
What term best describes a financial strategy used when an individual's income is too high to qualify for Medicaid?
What is a spend down