CBCS 19/20 Study Game Part 1

It involves reviewing the health record and/or encounter form and translating the medical doc into the specific code set

When an insurance company transfers data to allow coordination of benefits of a claim.

A group of submitted claims.

Lymphatic system does what?

An age-appropriate review of a patient's past and current activities.

Membrane surrounding the lungs and lining the walls of the pleural cavities

Describes the services rendered, payment covered, and benefit limits and denials.

An insurance claim that is submitted with errors.

Where can unlisted codes be found in the CPT manual

A review that looks at whether the procedure could be performed safely but less expensively in an outpatient setting.

Triangle Symbol

Five digit numeric codes for procedures & services performed by providers

The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets,

Billing patients for charges in excess of the Medicare fee schedule.

Why should a claim be submitted on paper instead of electronically?

Providers and facilities in a PPO's network.

HIPAA-mandated electronic transaction for claims.

Who is usually the Gatekeeper?

The symbol "O" in the Current Procedural Terminology reference is used to indicate what?

Code that covers physicians' services and hospital outpatient coding.

Intense pain along the nerve.

Combined package of benefits under Medicare Parts A and B that may offer extra coverage 

The extraction of specific data from a medical record, often for use in an external database, such as cancer registry.

Block 23

Software that helps coders assign the appropriate Medicare severity diagnosis-related group based on the level of servi

Information about health care services that patients have received and financial transactions that have taken place.

The HIPAA (ASC X 12N) institutional claim transaction.

Gunshot wound cases are...

Payments will be less if..

Block 33a

Discontinuing medical care without giving the proper notice or providing a competent replacement provider.

The document that provides permission to use & disclose individually identifiable health information other than for TPO

Provides hospitalization insurance to eligible individuals.

Improve accuracy and efficiency of coding, reduce training effort, and improve communication with physicians.

A coding book that contains codes for medical products and supplies.

Providers and facilities not on the formulary.

What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures?

Processes Medicare Parts A and B claims from hospitals, physicians, and other providers.

Code used for temporary coding for new technology & services that have not met requirements needed to be added to CPT

Preferred Provider

A part of HIPAA that outlines standards for maintaining pt confidentiality & safeguarding financial & admin data EHR

Where does the NPI number go on the CMS-1500 form?

Block 21

The on-going availability of cash for operations in a medical practice

Block 10a

Urine moves through the kidneys to the bladder through these.

DRGs (diagnosis-related groups)

Some senior HMOs provide services not covered by Medicare such as...

Identifies body part for medical or surgical procedure.

Abnormal growths of new tissue that are classified as benign or malignant

Block 17b

A list of prescription drugs covered by an insurance plan.

A written request for a verification of benefits.

Prohibits physicians from referring medicare pts for designated health services to another business 4 financial gain

Helps coders determine the appropriate ambulatory payment classification (APC) for an outpatient encounter.

Use of cold temperatures to destroy tissue

CPT codes published annually. These codes are added, revised, and deleted each year. The month you would start using thm

Surgical repair or unblocking of the coronary artery.

Codes used to classify visits when circumstances other than disease or injury are the reason for the appointment.

Codes used to classify environmental events, circumstances, and conditions, such as the cause of injury, poisoning

Block 27

Refers to the muscular wall of the heart.

Policy stating if a particular item or service is covered by Medicare.

The third-party payer reimburses the patient and the patient is responsible for reimbursing the provider.

Voluntary supplemental medical insurance to help pay for physicians' and other medical professionals' services

Which part of Medicare covers prescriptions?

Access is based on the role a person plays in an organization.

Claim submitted by people covered by a primary and secondary insurance plan.

Tumor of the bone marrow and bone.

In the anesthesia section of the CPT manual, what are considered qualifying circumstances?

Protects the confidentiality, integrity, and availability of electronic health information.

Releasing, giving access to, or transferring PHI to an outside person or organization.

Approval from the health plan for an inpatient hospital stay or surgery.

CPT codes are used to describe what?

Form required when a TRICARE member seeks medical services outside an military treatment facility.

Responsible for updating HCPCS and CPT changes.

An electronic document that lists patients, dates of service, charges, and the amount paid or denied by the ins carrier

Code designed to serve as supplemental tracking codes that can be used for performance measurement.

By signing block 12 of CMS-1500 form, a patient is doing what?

The main reason for the patient's visit.

Transaction code used by providers to communicate claims info with CMS. information about eligibility, enrollment, ETC,

A private health insurance that pays for most of the charges not covered by Medicare Parts A and B.

Auditing refers to...

An examination of a knee joint via small incision and optical device.

Providers and facilities within a broader, contracted network of the insurance company.

Z Code

HPI, PI

The transfer of electronic information in a standard form.

CMS 

Total number of modifiers that can be indicated on the CMS-1500 form.

Block 9a

Used for billing hospital services.

TPO

Medical etiquette refers to

a service company that receives electronic or paper claims from the provider, 

Surgical fixation of the stomach to the abdominal wall for correction of displacement.

Providers and facilities out of the network.

Software that suggests codes based on documentation or other input.

A remark code that can be on an Explanation of Benefits document.

Surgical removal of the tonsils.