MEDICAL BILLING & CODING LATEST 2023 GRADED A+

MEDICAL BILLING & CODING LATEST 2023 GRADED A+ CPT CURRENT PROCEDURAL TERMINOLOGY CPT IS PUBLISHED BY (AMA) AMERICAN AMERICAN MEDICAL ASSOCIATION CPT HAS SIX SECTIONS 1.Evaluation and Management codes starts with . 2. Anesthesia is . 3. Surgery is . 4. Radiology is . 5. Lab/Test is . 6. Medicare is CPT CODES ARE USED FOR SERVICE AND PROCEDURES/ ALSO WHERE PATIENT IS GOING AND WHAT DOCTOR IS DOING. CPT ONLY HAS 5 DIGITS IN THERE CODE PCP Primary Care Physician PPO Preferred Provider Organization EPO Exclusive Provider Organization HMO Health Maintenance Organization DME Durable Medical Equipment CHF CONGESTIVE HEART FAILURE UTI Urinary Tract Infection URI UPPER RESPIRATORY INFECTION NP NEW PATIENT OP OUT-PATIENT EMC ELECTRONIC MEDICAL CLAIM EDI ELECTRONIC DATA INTERCHANGE EIN NUMBER An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number, and is used to identify a business entity. SOB SHORTNESS OF BREATH SOF SIGNATURE ON FILE SOAP Subjective, Objective, Assessment, Plan CMS -1500 CENTERS FOR MEDICARE & MEDICAID SERVICE HCFA Health Care Financing Administration CBCS Certified Billing and Coding Specialist MR (Magnetic Resonance Imaging MR NUMBER Medical Record Number used for patient ID EOB Explanation of Benefits RA REMITTANCE ADVICE NPI National Provider Identifier CMAA Certified Medical Administrative Assistant WORKERS COMPENSATION A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment. MEDICARE PARTS Medicare: Part A, Part B, Part C, & Part D. Part A covers hospital Insurance. Part B covers Medical Insurance Physician visits and Out patient procedures. Part D Covers Prescription ICD-9 CODES International Classification of Disease Codes E, CODES Codes reported to identify how an injury occurred and the location when it occurred. V, CODES A sub-classification of ICD-9-CM coding used to identify health care encounters that occur for reasons other than illness or injury and to identify patients whose injury or illness is influenced by special circumstances or problems. HIPAA Health Insurance Portability and Accountability Act of 1996 HIPAA PROCEDURE CODES COVER BROAD ARRAY OF HEALTH-CARE SERVICES AND PROCEDURES DRG Diagnosis Related Group. Used only with Medicare and Inpatient stay. CPT SYMBOLS BULLET, PLUS SIGN TO ADD CODE, TRIANGLE TO REVISED CODE, TWO TRIANGLE SIDE BY SIDE, IS DESCRIPTION CHANGE. PAR IN-NETWORK PROVIDER NON-PAR OUT OF NETWORK PROVIDER AGING REPORT Report that shows how long debt has gone unpaid ANOTHER TERM FOR EOB REMITTANCE ADVICE (RA) ROLE OF A MEDICAL BILLER AND CODER TO MAKE SURE ALL MEDICAL BILLS ARE PROPERLY SUBMITTED. PREEXISTING CONDITION An illness or disorder of a beneficiary that existed before the effective date of insurance coverage. CLASSIFICATION IN WHICH RECORD ARE FILE IN MEDICAL OFFICES ACTIVE, INACTIVE, AND CLOSED ACCEPTED ASSIGNMENT Provider agrees to accept what insurance company approves as payment in full for the claim ENCOUNTER FORM a list of the procedures and charges for a patient's visit. Is also call super-bill. COINSURANCE 1. A cost-sharing requirement under a health insurance policy providing that the insured will assume a percentage of the costs for covered services. 2. For Medicare, after application of the yearly cash deductible, the portion of the reasonable charges (20%) for which the beneficiary is responsible. ICD-9 CODES HAVE DECIMAL POINTS IN IT WHAT IS THE MAIN TERM FOR CHEST PAIN PAIN ICD-9-CM CONTAINS CODE IN NUMERIC ORDER IS VOLUME ONE ICD-9 DISEASE CATEGORY CODES CONTAIN 3 DIGITS ICD-9 DISEASE SUB-CLASSIFICATION CODES CONTAIN 5 DIGITS ICD-9 IS PUBLISHED BY W.H.O ANNUALLY SUB CLASSIFICATION 5 digit that allows even more specific information about a disease SUB CATEGORY In ICD-9-CM, a four-digit code number that provides more information or specificity NCHS National Center for Health Statistics QUALIFIED DIAGNOSIS a working diagnosis which is not yet established HEALTH CARE CLEARINGHOUSE An entity that standardizes health information data in a standard billing format. DX DIAGNOSE COORDINATION OF BENEFITS Health insurance policy clause that applies to an individual covered by more than one medical insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim. ERA ELECTRONIC REMITTANCE ADVICE MEDICAL NECESSITY Linking every procedure or service code reported on the claim to an ICD-9 condition code t hat justifies the necessity for performing that procedure or service MODIFIER MODIFIER TO CPT TREATMENT CODE POS POINT OF SERVICE PLAN HIPAA PRIVACY RULE Law that regulates the use and disclosure of patients' protected health information (PHI). SAAS Software as a Service TRICARE A government health program that serves dependents of active-duty service members, military retirees and their families, some former spouses, and survivors of deceased military members; formerly called CHAMPUS. UB04 a commonly accepted hospital claim form UPIN Unique Physician Identification Number UCR usual, customary, and reasonable UTILIZATION LIMIT Always between zero and one. ANCILLARY SERVICES Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc. ADJUSTED CLAIM payment correction resulting in additional payments to provider