What do you mean?
An individual who receives insurance benefits due to a relationship.
Dependent
Types of medically necessary services covered by insurance (name 2)
Preventive care and routine vaccinations. ambulatory care, emergency care, inpatient care, diagnostic services
A federal health insurance program for people who are 65 or older.
Medicare
The first insurer to pay benefits when a patient is covered by more than one insurance.
Primary insurance
What does ICD mean?
International Classification of Diseases
A monthly payment made to purchase insurance coverage.
Premium
A system or strategy of managing health care in a way that controls all costs.
Managed Care
Coverage for US military members and their families
TRICARE
How many digits does a National Provider Identifier have?
10
What are ICD codes used for?
To identify diagnoses and inpatient procedures for insurance purposes.
A summary of coverage provided by an insurer to the subscriber and provider after an insurance claim is made
Explanation of benefits (EOB)
Least common type of managed care plan, patient must have a PCP, patient may see out-of-network providers for higher fee, premiums and copayments usually lower but deductibles are usually higher.
Point-of-Service Plans
Part of Medicare plan that covers outpatient visits, typically covers 80% of costs, and patient is responsible for remainder of costs
Part B
A company that specializes in reviewing insurance claims for errors and submitting claims to insurers on behalf of a provider/facility.
Clearinghouse
Tabular lists includes CPT codes in how many categories?
6
A standard fee for a treatment, service, or supply set by an insurer
Allowable Amount
Patient can see any provider out of network, does not require a PCP, patients have more flexibility
Preferred Provider Organizations (PPO)
Government program providing low-cost health insurance to families and pregnant women with low income.
Children's Health Insurance Program (CHIP)
What is the "birthday rule"?
The primary insurance is the plan of the parent whose month and day of birth falls earlier in the calendar year. Year does not matter.
Level II HCPCS codes have how many characters and how do the codes look?
5 characters; one letter followed by numbers
A federal law enacted in 2010 with the goals of making insurance affordable to more people.
Patient Protection and Affordable Care Act (ACA)
Patient must have a PCP, referrals must be made to other providers, plans are the most affordable, patient can only see providers on their list of services.
Health Maintenance Organizations
What does part D of Medicare cover?
covers prescription drugs
Claim details must include what? (Name 3)
Patient's diagnosis, date of service, treatment provided, procedures performed, location of service, provider's charges.
L codes in the HCPCS coding system are used for documenting what?
orthotic and prosthetic devices.