NHA CBCS Exam
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| show | Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust.
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| Compliance Regulations | show 🗑
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| show | Health Insurance Portability and Accountability Act of 1996.
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| show | Medical Procedures
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| show | Supplemental Codes for Performance Measures
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| Category 3 CPT codes | show 🗑
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| Add on Codes | show 🗑
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| show | 00100-01999, 99100-99140
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| show | Are listed first in the CPT manual because they are used by all the different specialties.
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| Brackets | show 🗑
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| Bullets | show 🗑
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| Chief Complaint (CC) | show 🗑
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| Circle with a line through it | show 🗑
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| CPT | show 🗑
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| E&M Codes | show 🗑
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| show | At the beginning of each section and used to provide specific coding rules for that section.
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| History (HX) | show 🗑
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| History of Present Illness (HPI) | show 🗑
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| show | Listed under associate and stand alone codes
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| E Codes | show 🗑
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| Level 1 codes | show 🗑
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| Level 2 codes | show 🗑
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| Level 3 codes | show 🗑
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| show | Appendix A and in the front of the book.
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| show | bilateral procedure
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| Modifier 24 | show 🗑
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| Modifier 26 | show 🗑
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| show | Used more than on procedure during the same surgical episode
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| show | Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified.
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| show | Physician must return to Operating Room to address complication stemming from initial procedure
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| show | Procedure or service provided during postoperative period not associated with initial procedure.
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| show | Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code.
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| Parentheses | show 🗑
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| Past, Family and Social History (PFSH) | show 🗑
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| Pathology and Laboratory | show 🗑
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| show | add on codes
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| show | 77010-79999
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| Review of Symptoms (ROS) | show 🗑
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| show | Contain full description to the procedure for a code.
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| Sideways triangle means | show 🗑
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| Bullet means | show 🗑
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| show | modifier 51 exempt code
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| show | E&M, Anatomical Site, Condition or Disease, Synonym or Eponym, Abbreviation.
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| Three Components for E*M Codes | show 🗑
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| Three Catagories for E*M Codes | show 🗑
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| show | New or existing patient, History, Physical Exam, Medical Decision making, Time spent can be a 5th factor
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| show | Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage.
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| show | Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ. Therapists etc.)
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| Medicare part C | show 🗑
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| show | Part D is stand-alone prescription drug coverage insurance.
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| show | free or low-cost health insurance coverage through the state
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| show | A distinction for individuals who fall into a specific category (or criteria)of mandatory Medicaid eligibility established by the federal government. These categories apply to every state Medicaid program.
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| show | provide Medicaid to certain groups not otherwise eligible for Medicaid.must cover: •Pregnant women •Children under 18.: States have option to cover:•Children up to 21•Parents and other caretaker relatives•Elderly•Individuals with disabilities
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| show | Medicaid is always the payor of last resort.
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| show | health care program for Uniformed Service members, retirees and their families
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| show | option that provides the most flexibility to TRICARE-eligible beneficiaries. It is the fee-for-service option that gives beneficiaries the opportunities to see any TRICARE-authorized provider.
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| TRICARE EXTRA (PP0) | show 🗑
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| TRICARE PRIME (HMO) | show 🗑
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| CHAMPVA | show 🗑
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| show | Private individuals are responsible for securing their own health insurance coverage. Commercial Government, Employer, Group health insurance coverage
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| show | An insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the benefits offered by many employers. These are generally uniform in nature, offering the same benefits to all members of group.
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| show | Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses
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| show | Health Maintenance Organization. A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles.
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| show | PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee.
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| show | feature of an insurance plan that allows a patient to choose between in-network care and out-of-network care every time he or she sees a doctor. The patient is allowed the freedom to go to whichever doctor is most convenient, although the cost will vary
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| Disability Insurance | show 🗑
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| Workman's Comp | show 🗑
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| Usual Customary and Reasonable | show 🗑
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| show | The payment amount for each service paid under the physician fee schedule is the product of three factors; a nationally uniform relative value for service; a geographic adjustment factor (GAF); a nationally uniform conversion factor for the service.
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| show | The schedule assigns certain values to procedures/costs based upon Total RVUs. The total consists of three components; work, practice expense, and malpractice. Medicare adjusts payment by geographic price cost index (GPCI) and pays depending on locale.
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| Clean Claim | show 🗑
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| show | A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment.
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| show | Any Medicare claim that contains complete, necessary information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring physician). Invalid claims re identified to the provider and may be resubmitted
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| Rejected Claim | show 🗑
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| ABN / Advance Beneficiary Notice | show 🗑
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| show | An insurance claim submitted on paper, including those opticaly scanned and converted to an electronic form by the insurance carrier
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| Electronic Claim | show 🗑
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| show | Developed by the AMA and the Centers for Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some private insurance/managed care plans
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| show | Patient Info, Verify Ins. Prepare encounter form, Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim, Transmit claim, Follow up on Reimbursement.
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| Review Linkage Protocol | show 🗑
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| Life Cycle of a Claim | show 🗑
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| show | Medicare Administrative Contractor
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| show | Complication
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| "A concurrent condition that coexists with the first-listed diagnosis or principal diagnosis, has potential to affect treatment of the aforementioned diagnosis and is an active condition for which the patient is treated and/or monitored." | show 🗑
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| The process by which the provider contacts the insurance carrier to see if the proposed procedure is covered by a specific patients insurance policy. | show 🗑
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| show | Accounts Receivable (A/R)
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| show | Accounts Payable (A/P)
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| What are the names of the three tables that appear in the Index to Diseases? | show 🗑
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| show | Remittance Advice
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| show | Balance Billing
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| show | Medicare
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| show | Medicaid "payer of last resort"
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| show | Medicare
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| show | Affordable Care Act (ACA)
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| Person who is responsible for a patients debt is called? | show 🗑
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| Medicare beneficiaries can also obtain supplemental insurance called what? | show 🗑
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| show | Helps cover costs not reimbursed by the original Medicare plan.
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| A writ requiring the appearance of a person at a trial or other proceeding is a ___________. | show 🗑
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| show | After the primary and secondary insurers.
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| Healthcare Common Procedure Coding System (HCPCS) | show 🗑
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| A managed care organization that establishes a network of providers who care for their patients is called a/an _________. | show 🗑
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| A group that takes nonstandard medical billing software formats and translates them into the standard Electronic Data Interchange (EDI) formats is called a/an? | show 🗑
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| The out-of-pocket payment amount that a policyholder must meet before insurance covers the service(s) is called? | show 🗑
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| National Provider Identifier (NPI) number | show 🗑
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| What is a capitation? | show 🗑
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| A fixed fee collected at the time of the patients visit. | show 🗑
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| A fixed percentage of covered charges applied to the patients bill after the deductible has been met. | show 🗑
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| The charge for keeping the insurance policy in effect. | show 🗑
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| show | Abuse
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| show | An intentional deception of misrepresentation.
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| show | Intent
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| Current Procedural Terminology (CPT) codes | show 🗑
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| Is Abuse intentional? | show 🗑
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| show | Roster Billing
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| show | Claimant
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| show | Liability Insurance
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| A detailed accounting of the claims for which payment is being made by an insurance company. The __________ accompanies the payment from the insurance company. | show 🗑
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| Authorization by a policyholder that allows a payer to pay benefits directly to a provider is called? | show 🗑
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| show | Inpatient
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| What is confidentiality? | show 🗑
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| show | Principal diagnosis
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| show | Participating Providers
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| show | Compliance Plan
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| What act mandated the reporting of ICD-9-CM diagnosis codes? | show 🗑
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| show | Electronic Data interchange (EDI)
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| show | Malignant
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| show | Benign
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| "No notation of benign or malignant status is found in the diagnosis or in the patient's chart." | show 🗑
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| show | Comorbidities and Complications
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| What does policy mean? | show 🗑
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| show | Payee
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| show | Policyholder
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| True or False, Preferred Provider Organizations (PPO)s never allow members to receive care from physicians outside the network. | show 🗑
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| show | Confidential
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