Office Financial Management, Billing & Insurance

Question 1

Bookkeeping

Answer 1

Record of financial transactions.

Question 2

What are the 5 types of transactions?

Answer 2

1) Asset - resources
2) Liability - debts
3) Income - revenue
4) Expense - purchases
5) Equity - earnings

Question 3

Double-entry Bookkeeping

Answer 3

Every transaction effects 2 accounts by increasing one & decreasing the other.

Question 4

Fee Schedule

Answer 4

A complete listing of fees that are used to pay doctors or other providers/suppliers

Question 5

Resources-based Relative Value Scale

RSBRVS

Answer 5

A payment system that is used to calculate medical payments for physician services by the CMS.

Question 6

Diagnosis-Related Groups

DRGs

Answer 6

CMS pays for inpatient care based on principle diagnosis, age, and other complicating issues.

Question 7

Contracted Fees

Answer 7

A benefit plan that prohibits extra billing.

Question 8

What does CMS stand for?

Answer 8

Centers for Medicare & Medicaid Services

Question 9

ICD-10-CM stand for

Answer 9

International Classification of Diseases, 10th Revisions, Clinical Modification.

Question 10

HCPCS stand for

Answer 10

Health Common Procedure Coding System

Question 11

CPT stand for

Answer 11

Current Procedural Terminology

Question 12

Purpose of HCPCS

Answer 12

Used to fill claims for equipment, supplies and services that are not covered by CPT codes.

Question 13

What is CPT?

Answer 13

A primary code system used to describe the treatment services provided for that diagnosis.

Question 14

HCPCS Level 1

Answer 14

Identical to CPT codes, b/t when used bill Medicare/Medicaid it will used HCPCS codes.

Question 15

HCPCS Level 2

Answer 15

Designed to represent non-physician services & supplies (e.g., ambulance) that aren’t covered by HCPCS Level 1.

Question 16

Who’s eligible for Medicare?

Answer 16

1) 65+ year old
2) Disability person who has received Social Security benefits for 2 years.
2) Anyone with End Stage Renal Disease (ESRD)

Question 17

Who’s eligible for Medicaid?

Answer 17

1) Low-income persons
2) Children who qualify for public assistance.
3) Disability

Question 18

Medigap Policy

Answer 18

Health insurance plan that helps pay medical expenses not covered by Medicare.

Question 19

Work Compensation

Answer 19

A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment.

Question 20

TRICARE or CHAMPUS

Answer 20

Provide healthcare for active & retired military personnel and their families.

Question 21

Fee-for-service Compensation

Answer 21

Plan in which doctors/providers are paid for each service they render.

Question 22

Dependents

Answer 22

Family members allowed to be included on an insurance plan.

Question 23

Premium

Answer 23

Fee that an individual pays for insurance coverage.

Question 24

Co-insurance

Answer 24

Requires that specific percentages of expenses are shared by the patient & insurance company.

Question 25

Deductible

Answer 25

An amount that must be paid by the patients for medical services before the policy begins to pay.

Question 26

Co-payment

Answer 26

A specific amount of money a patients pays for particular service.

Question 27

Employer-Sponsored Health Insurance

Answer 27

Most people have insurance through their place of employment.

Question 28

HMO stand for

Answer 28

Health Maintenance Organization

Question 29

HMO

Answer 29

A medical insurance that provides health services for a fixed monthly fee.

Question 30

PPO stand for

Answer 30

Preferred Provider Organization

Question 31

PPO

Answer 31

* Contract with certain agencies (hospital/doctors) to provide health care reduced rates. * Restricted to using a specific hospital & doctors

Question 32

Medicare Part A

Answer 32

A health insurance that pays for hospitalization, care in a skilled nursing facility, home health care, and hospital care.

Question 33

Medicare Part B

Answer 33

A medical insurance that covers outpatient treatment (e.g., lab testing, doctor appointment).

Question 34

Medicare Part C

Answer 34

An additional insurance option, which covers Medicare Part A & B.

Question 35

Medicare Part D

Answer 35

Provides prescription drug coverage.

Question 36

CHAMPVA stand for

Answer 36

Civilian Health and Medical Program of the Department of Veterans Affairs.

Question 37

CHAMPVA

Answer 37

Covers the families of vets who were killed or permanently disabled in the line of duty, who are ineligible for TRICARE.

Question 38

CHAMPUS stand for

Answer 38

Civilian Health and Medical Program of the Uniformed Services