medicare severity diagnosis related groups (MS-DRG)

grouping of patients/similar condition/ same amount of reim.

national provider identifier (NPI)

10 digit identification number assigned to health care pro.

Advanced Beneficiary Notice ABN

potential denied service that may have to be paid by patient

HMO- Health Maintenance Organization

manage care plan/limited group of providers/predetermined fe

CPT- Current Procedural Termniology

code specified in the CPT code book

a person eligible for coverage government health policies

claim form submitted with no errors

Coordination of benefits

procedures to prevent duplication of payment

amount insurance companies consider to be an appropriate fee

Primary Care Provider (PCP)

gatekeeper provider who refers patients to other providers

obtaining prior approval for surgery and other procedures

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Chapter 14 terms Medical billing MOD 5

31 termsStudBud Administration298 plays

#medicalbilling

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Questions 31

Answers

1
fee schedule- schedule of the amount paid by a specific ins. co. for each procedure to the MCC
false
True
2
CMS-1500
procedures to prevent duplication of payment
most common health insurance claims for physicians service
predetermined amount of money the patient must pay
3
elective procedure- medical procedure that is nonemergent but may benefit the patient
true
false
4
Copayment
amount money patient pays determined by insurance co.
amount of money patient receives back from ins.co
money owed to the insurance co.
5
HMO
health maintenance organizaton
home management organization
health maintenance organs
Health manage organizing
6
NPI
Naming Physician Identifier
National pain Identifier
National Provider Identifier
National physician Identifier
7
medicare severity diagnosis related groups (MS-DRG)
grouping of patients/similar condition/ same amount of reim.
the insurance policy billed first for any healthcareservice
private insurance policy that is sold to those receiving
amount paid for insurance
8
national provider identifier (NPI)
10 digit identification number assigned to health care pro.
number for the patient
identifying letters 10 digits long
9
Advanced Beneficiary Notice ABN
amount insurance co. consider to be an appropriate fee
schedule amount paid by specific insurance co. for procedure
potential denied service that may have to be paid by patient
primary care provider who refers patients
10
CPT- Current Procedural Terminology
True
False
11
primary policy- the insurance policy billed first for any health care
true
false
12
HMO- Health Maintenance Organization
the process of establishing the medical need for service
manage care plan/limited group of providers/predetermined fe
13
COB
Coordinating of beneficary
coordinating of benefiting
Coordination of Benefits
14
CPT- Current Procedural Termniology
code specified in the CPT code book
prior pre approval for insurance
manage care plan
medical procedure that is nonemergent
15
Coinsurance is a fixed percentage of charges the patient must pay under a given insurance polic
True
false
16
Beneficiary
a person eligible for coverage government health policies
a person eligible to obtain family property
eligibility to claim money on a insurance claim
17
Centers for Medicare and Medicaid Services (CMS)
private insurance policy additional coverage
manage care plan limited group of providers predetermined fe
administers medicare program
primary care provider who refers patients to other providers
18
PCP
Physician care provider
Perferred company provider
Primary company provider
Primary Care Provider
19
medical necessity- the process of establishing the medical need for medical services
true
false
20
clean claim
amount paid for insurance
insurance policy billed first for services
claim form submitted with no errors
fixed percentage of chargers the patient must pay
21
Coordination of benefits
predetermined amount of money the patient must pay
procedures to prevent duplication of payment
obtain preapproval
amount paid for insurance
22
gatekeeper- a PCP who refers patients to other providers for services he or she cannot perform
true
false
23
MCO
medicare coordination organization
Manage care organization
medicaid care organization
Manageable Company organization
24
Medigap (MG) private insurance policy that is sold for additional coverage
true to medicare patients
false
25
MG- Medigap
true
false
26
Premium- amount paid for insurance
false
true
27
Allowed Amount
insurance claim used to file claims for services
a person eligible for coverage by government health policies
insurance companies require preapproval elective procedure
amount insurance companies consider to be an appropriate fee
28
DRG -Diagnosis Related Group
False
True
29
Primary Care Provider (PCP)
gatekeeper provider who refers patients to other providers
provider who accepts patients from a gatekeeper
30
ABN
Advanced Benefiting Notice
Advance Benefit notation
Advanced Beneficiary Notice
Advantage Benefit Note
31
preauthorization
cpt coding
obtaining prior approval for surgery and other procedures
10 digit number
amount paid for insurance

Chapter 14 terms Medical billing MOD 5 Flashcards | StudBud