ICD-10-CM Coding
What does the abbreviation CM stand for in ICD-10-CM?
Clinical Modification
How often are CPT codes revised?
Annually
What is a child covered under their parent's health insurance called?
Dependent
What is the universal claim form used to submit professional medical insurance claims?
CMS-1500
Where does outpatient medical care commonly take place?
Health care provider's office
What organization first instituted the diagnostic classification system?
World Health Organization (WHO)
What are the most frequently used CPT codes in the medical office?
Evaluation and Management (E/M codes)
What type of insurance plan is sponsored by an employer or union?
Group plan
What is the name of the statement a patient recieves explaining how an insurance claim was processed and paid?
Explanation of benefits (EOB)
What is the name of the list that shows how much a medical office charges for each service?
Fee schedule
Name the three formats in which ICD-10-CM is avaliable?
Manual, computer software and web-based format
What is the purpose of using modifiers in CPT coding?
To provide additional information about a procedure or service
When a patient has more than one insurance plan, which is billed first?
Primary Insurance. (if it is a dependent child: use birthday rule)
What is it called when insurance claims are submitted using a computer over the internet?
Electronic claims submission
What is an encounter form used for in a medical office?
To record patient services, procedures, and charges
What is the purpose of supplementary ICD-10-CM codes?
To provide additional information about a patient visit
Name three services or supplies included in HCPCS Level II codes?
Ambulance services, durable medical equipment and prosthetics
What is the payment system called when a physician receives payments based on the number of patients enrolled in a plan?
Capitation
What is the name of a claim that is automatically forwarded from Medicare to Medicaid?
Crossover claim
True or False: Medical decision making refers to the decisions a physician makes to establish a patient diagnosis
True
True or False: ICD-10-CM codes provide detailed descriptions of diseases, injuries, and conditions and use alphanumeric codes containing three to seven characters?
True
Why is it important to use updated CPT codes when submitting insurance claims?
To help prevent denials of medical insurance claims
What is the name of the agency that processes claims and payments for a self-funded insurance plan?
Third party administrator (TPA)
What is billing medical services that were never performed called?
Fraud
According to the textbook, when financial data is stored electronically, what additional type should be kept as a backup?
Hard copy (printed record)