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What does HIPAA stand for?
Health Insurance Portability and Accountability Act
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This type of insurance is obtained through your job.
Major Medical
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This type of insurance is for Automobile accidents.
No Fault
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This type of insurance is for Disability / Injury on the job.
Worker's Compensation
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This type of insurance is form the government for ages 65 and older.
Medicare
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This type of insurance is from the government for lower income persons.
Medicaid
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This term refers to a small amount of money to be paid at the time of visit.
Co-Payment
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This term refers the remaining percentage amount of the medical bill not covered by the insurance company.
Co-Insurance
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This term refers a set amount of money that must be spent on medical services befroe the insurance company will begin reimbursing any amount.
Deductible
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This term refers to an extension on a patient's policy that must be there for Acupuncture coverage.
Rider
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This term refers to any healthcare professional that provides healthcare to a patient.
Provider
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There are two types of providers, what are the differences?
- In Network:
- Signed contract with insurance companies
- Obligated to that contract
- Directory Listing
- Often no deductibles
- Pays less than Out of Network
- No balance billing
- Out of Network:
- No contract
- No obligations
- Balance billing allowed
- Pays more than In Network
- No directory listing
- Always deductibles
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What does CPT stand for?
- Current Procedural Terminology (Procedure Codes)
- Examples of CPT codes:
- Unit
- Acupuncture
- Evaluation & Management
- Modifiers
- Other
- *Acupuncture is under CPT's (Physical Medicine & Rehabilitation)
- *Owned by American Medical Association (AMA)
- *'There is no guarantee of payment when using these codes
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What are the Unit Codes for Regular Acupuncture?
- 97810 - 1 unit (first 15 mintues)
- 97811 - 1 or more units (additional 15 minutes after first unit)
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What are the Unit Codes for Electric Acupuncture?
- 97813 - 1 unit (first 15 mins)
- 97814 - 1 or more units (additional 15 mins after the first unit)
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What are the codes for Evaluation & Managemant?
- 99201-99205 (10-40, 60 mins, respectively)
- 99211-99215 (10-50 mins, respectively)
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What is modifier "25"?
- Separates Exam from Treatment
- Tells insurance that exam in not part of Acupuncture codes
- (i.e. 99203-25 -- 30 min exam)
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What are other commonly used CPT codes?
- 97124: Massage
- 97140: Myofacial Release
- 97026: Infrared
- 97010: Heat & Cold packs
- 97016: Vasoneumatic Device (cupping)
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What does ICD stand for?
- International Classification of Diseases (Diagnosis Codes)
- "Pain" is acceptable but specificity if best
- Additional digit give specificity:
- 719: joint disorder
- 719.0: effusion of joint
- 719.04: effusion of joint, Hand
- *digits are important
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What does HICF stand for?
- Health Insurance Claim Form
- *this is the main form sent to insurance companies
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What does Accept Assignment mean (HICF 1500-Box 27)?
- If Yes: check comes to you
- If No: check goes to patient
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When seeing a patient, the practitioner who is not a contracted provider with the insurer can settle the payment by which methods?
- Let the patient pay for the treatment, and give the patient an invoice
- Send the bill to the insurer for the patient, but let the patient pay for the treatment
- Send the bill to the insurer and wait for payment from the insurer
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Which insurer does not cover acupuncture at the time?
Medicare
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What does NCCAOM stand for?
National Certification Commision for Acupuncture and Oriental Medicine
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Upon successful completion of the NCCAOM Examination on Acupuncture, a person would earn the title of what?
Diplomate of Acupuncture
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One of the benefits of remaining active in NCCAOM Status after successful examination is achieved is what?
- You are listed in their directory of practitioners for your title and receive E Newsletters
- They send verification of you status to third party payors for free
- There are reduced fees for exam results, certification verification, etc
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Upon successful completion of the NCCAOM Examination, you are considered to be what?
Active Status
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You must Recertify with the NCCAOM every___ years.
4 Years
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Anyone who does not Recertify within the appropriate time frame is considered what?
Expired
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In order to Recertify, you must have accumulated how many points?
60 PDA (Professional Development Activity) Points
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A person who does not Recertify may register to be Inactive and remain Inactive for how long?
2 Years
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If a person's status becomes Expired, they may become permanantly Terminated within a period of how many years (as of 2013)?
3 Years
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Practitioners wishing to combine an Acupuncture Certification with an Herbal Certification are going to obtain the title of what?
Oriental Medicine
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To help Certified Practitioners in their practices, NCCAOM has begun to offer a what?
- Website package
- Marketing and Lobbying courses
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What brochures are available from NCCAOM?
- Acupuncture
- Chinese Herbology
- Asian Bodywork Therapy
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Is there a special code for NYCTCM for NCCAOM application material?
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