Financial Practices Exam1

  1. pre-determined 12 month period for financial purposes
    Fiscal year
  2. pt with more than 1 insurance; nothing to do with birthday rule
    Coordination of Benefits
  3. Usual Customary and Reasonable
  4. OV
    Office Visit - CPT Book
  5. CPT
    Current Produral Terminology
  6. ICD
    International Classification of Diseases
  7. HCPCS
    Healthcare Common Procedure Coding System
  8. PPO
    Preferred Provider Organization; network together to offer discounts
  9. PCP
    Primary Care Physician
  10. HMO
    Health Maintenance Organization; usually require pre-authorization
  11. CMS
    Centers for Medicare and Medicaid Services
  12. CMS-1500
    health insurance form
    insurance for spouses and unmarried dependents of a veteran who is diabled or died or a service related injury
  14. Tricare
    insurance for dependents of active duty and retired military personnel and dependents of those who died in active duty
  15. EOB
    Explanation of benefits
  16. Co-insurance
    the percentage paid by the company or the insured
  17. Co-payment
    small payment required when seen by the provider
  18. Statute of limitations
    defines the period in which legal action can take place
  19. Elective Procedures
    procedures that are not medically necessary
  20. Primary insurance
    the policy with the earliest effective date
  21. Pre-certification
    determines whether a service or procedure is covered and if the insurance plan approves it as medically necessary
  22. Unbundling
    refers to separating the components of a procedure to increase reimbursement; fraudulent
  23. Assignment of benefits
    instruction to the insurance company about whom and where to make payment
  24. Major medical
    insurance designed to offset medical expenses of a catastrophic degree high deductible.
  25. Does medicare have a deductible
  26. How much does medicare generally pay
    80% of UCR after deductible
  27. 7 sections of the CPT
    Anesthesia, surgery, pathology/lab, evaluation and management, radiology, medicine
  28. 2 major sections of ICD
    Diagnostic and procedure
  29. Superbill
    identifies the procedures performed, diagnoses, charges, and when to return.
Card Set
Financial Practices Exam1
Exam 1