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CBCS Exam
Certified Billing and Coding Specialist
Term | Definition |
---|---|
Improper code combinations | Describes the reason for a claim rejection because of Medicare NCCI edits |
Appeal the decision with a provider's report | Action taken if an insurance company denies a service as not medically necessary |
Gross examinaion | A coroner's autopsy is comprised of examination by which specimens are inspected with the bare eye |
Down's syndrome | conditions associated with microcephaly, a smaller than normal head circumference. |
Appeal | is the process used to challenge a payer’s decision to deny, reduce or downcode a claim |
10-pitch PICA font | font is the standard font that should be used for paper claims |
Excision (Any term that ends in –ectomy indicates an excision) | The subsection in the CPT manual, an esophagectomy can be found in |
Attending physician | is responsible for the patient’s care, as well as discharge decisions, therefore, he should be notified of abnormal lab results before the nurse can proceed with discharge planning. |
Pathology and Laboratory | section of the CPT manual that lists the appropriate code for white blood count (WBC) with differential automated |
Check for a fourth or fifth digit | To assign a diagnosis code to the highest level of specificity |
Proper coding sequence of a patient who suffers 2nd degree burn of the left axilla and 3rd degree burn of wrist. 12% was burned, with 3% of the burns designated as third-degree. | 3rd-degree burn of wrist; 2nd-degree bur of axilla, burn involving 10 to 19% of the body surface with less than 10% of that being third-degree burns. |
Coinsurance | Describes when a plan pays 70% of the allowed amount and the patient pays 30% |
Clinical Laboratory Improvement Amendments (CLIA) | is the accreditation agency for office laboratories, & therefore, can review manuals & interview staff |
Medicine section of CPT manual | where the code for hemodialysis is found |
V codes | are used as the first-listed diagnosis to identify health encounters that occur for reasons other than illness or injury. |
Reporting test results to a family member via phone does | HIPAA violation description |
Private third-party payers | Medigap coverage offered to Medicare beneficiaries |
Endocrinologist | Medical specialist who the primary care provider (PCP)) refer the patient who has a new onset of diabetes mellitus to further treat the disease |
Informing the supervisor of the observation | an action a billing and coding specialist takes when she observes a coworker drinking alcohol during work hours |
Health care clearinghouses | are covered entities (the middle man between the provider & the payer) affected by HIPAA security rules. |
The claim is overdue for payment | describes a deliquent claim |
Aorta | transports oxygenated blood from the heart |
The DOB is entered incorrectly | reason the claim was rejected because the patient Jane Austin's DOB was entered 052245 not 05221945 |
National Provider Identifier (NPI) | is required to identify the rendering provider on the CMS-1500 in Block 24J According to HIPAA standards |
Military Identification | are required cards that pertain to retirees, active duty sponsor, and their eligible family members 10 years of age or older as a means of identification for TRICARE |