Coding and billing

Question 1

Medicare

Answer 1

Covers 65 and older and some persons under 65 who qualify.

Blind or have serious long term disabilities

Question 2

HMO

Answer 2

Only offer in network benefits
Providers usually paid by capitation
Health Maintenace Organization

Question 3

Workers compensation

Answer 3

Covers those who get hurt on the job

Question 4

Coordination of benefits is done

Answer 4

To prevent duplication of payment

Question 5

Physician fee schedule

Answer 5

List of the usual fees for procedures and services

Question 6

Universal paper claim

Answer 6

CMS-1500

Question 7

CHAMPVA

Answer 7

Covers surviving spouses and dependent children of veterans who died in the line of duty or as a result of a service connected disability.

Question 8

Medicare part D

Answer 8

Cover prescriptions

Question 9

RBRVS

Answer 9

Fees are lower than usual fees
Scale used by Medicare
Replaces usual and customary charges used by third party payers to determine fees

Question 10

Medical billing program

Answer 10

Makes the process of creating and following up on claims easier

Question 11

DDE

Answer 11

Third party payers online system

Question 12

Benefit

Answer 12

Payment for medical services

Question 13

Co payment

Answer 13

Small fixed fee collected at the time of visit

Question 14

Premium

Answer 14

Charge for keeping the insurance policy in effect

Question 15

Deductible

Answer 15

Fixed dollar amount that must be paid or met once a year

Question 16

Coinsurance

Answer 16

Fixed percentage of covered charges after the deductible is met

Question 17

PPO

Answer 17

Offers in and out of network benefits discounts are given for using network providers

Question 18

GAF

Answer 18

An adjustment factor used to reflect the area of the country where the service was performed

Question 19

CF

Answer 19

Used to make adjustments according to the cost-of-living index

Question 20

RVU

Answer 20

Based on the physician’s work, the practice cost and the cost of medical malpractice

Question 21

ICD-10 codes

Answer 21

5th position
Maintained by (WHO)
International Classification of Diseases, Tenth Revision

Question 22

Diagnoses

Answer 22

The primary condition for which a pt is receiving care.

Question 23

Z codes

Answer 23

Identify encounters for reasons other than illness or injury

Question 24

R codes

Answer 24

AN abnormal finding without an actual diagnoses being available.

Question 25

X placeholder

Answer 25

ICD-10 codes used to hold a place for future expansion of the codes specificity

Question 26

which organization requires that you use ICD-10 codes

Answer 26

The Health Portability and Accountability Act

Question 27

Tabular list

Answer 27

Diagnosis codes and descriptions

Question 28

Most frequently used CPT codes

Answer 28

Evaluation and management codes

Question 29

How many codes are required for giving a pt an injection of a vaccine

Answer 29

2

Question 30

Moddifiers CPT codes indicate

Answer 30

That some special circumstances applies to the service Special circumstances apply to the procedure

Question 31

Surgery procedures on the spleen and bone marrow

Answer 31

Hemic / Lymphatic systems

Question 32

CPT codes updated and new codes are provided

Answer 32

Annually on January 1 They have 5 digit numeric codes

Question 33

What is the maximum # of modifiers that can be assigned per CPT procedure code

Answer 33

4

Question 34

Is NOT one of the 6 main sections of the CPT manual

Answer 34

Physical Therapy

Question 35

Claim form

Answer 35

The patient charge slip

Question 36

Electronic claim the billing provider is

Answer 36

The entity transmitting the claim to the payer

Question 37

Claims accepted by payers for processing

Answer 37

Clean claims

Question 38

Submit electronic medical claims to third party payers

Answer 38

Clearinghouse

Question 39

CPD code format

Answer 39

5 digit numeric codes

Question 40

Find CPT coding manual you would look

Answer 40

Introduction to the manual