Key Concepts in Health Insurance and Medical Billing

Study guide Question The authorization for an insurance carrier to pay the physician or the medical practice directly is the ____. The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____. Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n) ____. Which of the following is a characteristic of Medicaid? A patient's diagnosis as established by the physician ____. ICD codes are updated ____. The Alphabetic Index is organized by ____. Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older. Who most frequently files insurance claims and handles insurers' payments for a medical practice In most cases, the insured person pays an annual cost or ____ for healthcare insurance An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____. Which of the following is what the patient owes after the insurance company has paid? To be covered under Medicare Part B, patients must ____. The most frequently used CPT codes are the ____. Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property? When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered Which of the following conventions is used in ICD-9 and ICD-10 to indicate that the entries following it further define the content of a preceding entry? The person whose name the insurance is carried under is called the ____. In a typical medical practice, insurance claims are filed The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____. A patient who has been hospitalized up to 90 days for each benefit period is covered under The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days. Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ____, may be entitled to Medicare. Which of the following is included in Medicare benefits for respite care? The Healthcare Common Procedure Coding System (HCPCS) was developed for use in coding services for ____. A plus sign (+) is used to indicate ____. HCPCS Level I codes ____. Modifiers to CPT codes indicate ____. Answer assignment of benefits deductible copayment is a health cost assistance program describes the primary condition for which the patient is receiving treatment annually the symptoms displayed by the patient Medicare Medical assistant premium review for allowable benefits Patients liability qualify for part A, but sign up for B E&M codes liability fraudulent Includes subscriber a few business days after the date of service rejected Medicare Part A 60 kidney failure The terminally ill patient is moved to a care facility for the respite. Medicare patients add-on codes are aka cpt codes that some special circumstance applies to the service Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except National codes issued by CMS that cover many supplies and durable medical equipment are Which of the following is not one of the six main sections in the CPT manual? The CPT is updated and new codes are provided for use beginning find information regarding prefixes and suffixes used in the CPT manual, you would look in the Which of the following best describes the CPT code format Which of the following is an implication for the patient if the patient pays by credit card? The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____. If a medical practice accepts credit card payments, the American Medical Association (AMA) suggests the use of which guideline? If your medical practice does not have an authorization device for credit card payment, ____. Which of the following patients would a physician most likely treat as a matter of professional courtesy? Which of the following statements applies to a physician who agrees to accept Medicaid patients? Which of the following ICD-9-CM conventions is used around synonyms, alternative wordings, or explanations? When do most smaller practices send out their statements A common billing system that bills each patient only once a month but spreads the work of billing over the month is ____. The Alphabetic Index is organized by ____. In a typical medical practice, insurance claims are filed The Tabular List is mainly organized by ____. Which convention is used in ICD-9 and ICD-10 to indicate that an entry is not classified as part of the preceding code? Analysis of the connection between the diagnostic and procedural information on a claim is called The person whose name the insurance is carried under is called the ____. __________is not one of the six main sections in the CPT manual? How much will a medical practice generally receive if a physician charges $100 for services and the patient pays by credit card? Most of a physician's long-standing patients have a(n) ____. An initial letter of inquiry is generally sent when an account is ____ days past due A written-contract account is ____. internal coding audits HCPCS Level II codes Physical therapy annually on January 1 Introduction to the manual 5-digit numeric codes If the patient doesn't pay the credit card balance in full, interest accrues on the unpaid balance denied because the treatment was not medically necessary based on the diagnosis Do not advertise this. call the credit card company for authorization Other healthcare professionals The physician can bill the patient for services that Medicaid does not cover [] At the end of the month cycle billing diagnosis or condition description a few business days after the date of service the body system involved Excludes code linkage subscriber Physical Therapy $95-$99 open-book account 60 one in which the physician and patient sign an agreement for payment installments