Nha Cbcs

E Codes - correct answer For durable medical equipment for use in home Chief Complaint (CC) - correct answer The reason the patient came to see the physician. Past, Family and Social History (PFSH) - correct answer Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family; Patients educational background, occupation, marital status and other factors Add on Codes - correct answer Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately. What act mandated the reporting of ICD-9-CM diagnosis codes? - correct answer The Medicare Catastrophic Coverage Act of 1988 Electronic Data interchange (EDI) - correct answer Transmitting electronic medical insurance claims from providers to payers using the necessary information systems is called Medical Ethics are - correct answer Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust. Three Components for E*M Codes - correct answer 1.History 2.Physical Exam 3.Medical Decision-Making Guidelines are Found? - correct answer At the beginning of each section and used to provide specific coding rules for that section. Co-payment - correct answer A fixed fee collected at the time of the patients visit. Review Linkage Protocol - correct answer Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance with regulation and guidelines What is confidentiality? - correct answer Involves restricting patient information access to those with proper authorization and maintaining the security of patient information. What are the names of the three tables that appear in the Index to Diseases? - correct answer Hypertension Neoplasm Table of Drugs and Chemicals Level 2 codes - correct answer National codes for physician and non-physician service not found in the CPT Level 1 Inpatient - correct answer A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for treatment with the expectation that the patient will remain in the hospital for a period of 24 hours or more. HIPAA is an acronym for - correct answer Health Insurance Portability and Accountability Act of 1996. Life Cycle of a Claim - correct answer Submission, Processing, Adjudication, Non-covered, Unauthorized, Medical Necessity Checks, Payment / RA / ERA Level 1 codes - correct answer Codes found in the CPT manual Deductible - correct answer The out-of-pocket payment amount that a policyholder must meet before insurance covers the service(s) is called? Coinsurance - correct answer A fixed percentage of covered charges applied to the patients bill after the deductible has been met. Liability Insurance - correct answer Covers injuries caused by insured that occurred on the insured's property. Unspecified - correct answer "No notation of benign or malignant status is found in the diagnosis or in the patient's chart." subpoena - correct answer A writ requiring the appearance of a person at a trial or other proceeding is a ___________. Medicare - correct answer What is the single largest healthcare program in the United States? Parentheses - correct answer Used to enclose supplementary words; non essential modifiers Indemnity insurance - correct answer Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses Rejected Claim - correct answer A rejected claim is an electronically submitted claim that is unprocessable due to missing or invalid information required by the payer. - correct answer Radiology Medicaid Medically Needy - correct answer provide Medicaid to certain groups not otherwise eligible for M cover: •Pregnant women: •Children under 18: •States have option to cover: •Children up to 21: •Parents and other caretaker relatives: •Elderly: •Individuals with disabilities: Brackets - correct answer Used to enclose synonyms, alternative wording or and explanatory phrase Modifiers - correct answer Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code. Medicare part A - correct answer Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Medicare part B - correct answer Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ. Therapists etc.) Medicare part C - correct answer Part C is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. Medicare part D - correct answer Part D is stand-alone prescription drug coverage insurance. HMO - correct answer Health Maintenance Organization. A form of health insurance combining a range of coverage's in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles. PPO - correct answer PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee. Clean Claim - correct answer A completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly. Dirty Claim - correct answer A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment. Invalid Claim - correct answer Any Medicare claim that contains complete, necessary information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring physician). Invalid claims re identified to the provider and may be resubmitted Advance Beneficiary Notice - (ABN) - correct answer A notice that a doctor, supplier, or provider gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment. Electronic Claim - correct answer An insurance claim submitted to the insurance carrier via a central processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in telephone, digital fax, or personal computer download or upload CMS 1500 Universal Claim Form - correct answer Developed by the AMA and the Centers for Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some private insurance/managed care plans What does MAC stand for? - correct answer Medicare Administrative Contractor EHR - correct answer Electronic Health Record AMA - correct answer American Medical Association ARRA - correct answer American Recovery and Reinvestment Act of 2009 CMS - correct answer Centers for Medicare & Medicaid Services MAC - correct answer Medicare Administration Contractor TIN - correct answer Tax Identification Number EFT - correct answer Electronic Funds Transfer ACA - correct answer Affordable care Act NHA - correct answer National Healthcare Association-Started 1989 PQRS - correct answer Physician Quality Reporting System EDI - correct answer Electronic Data Interchange EP - correct answer Eligible Provider ERA - correct answer Electronic Remittance advicer NPI - correct answer National Provider Identification EMR - correct answer Electronic Medical Record EOB - correct answer Explanation of Benefits EHR - correct answer Electronic Health Record FFS - correct answer Fee for Service ARRA - correct answer American Recovery Reinvestment Act of 2009