HC21 INSURANCE & CODING MODULE QUESTIONS AND ANSWERS 2024/2025
1 view 0 purchase
Course
HC 21
Institution
HC 21
Claim
→ a document sent to an insurance carrier demanding payment for services provided to
an insured patient or an insured beneficiary
correct coding
→ is a legal issue. if coding is performed improperly, the assistant could be charged with
fraud
tertiary insurance
→ patients covere...
HC21 INSURANCE & CODING MODULE
QUESTIONS AND ANSWERS 2024/2025
Claim
→ a document sent to an insurance carrier demanding payment for services provided to
an insured patient or an insured beneficiary
correct coding
→ is a legal issue. if coding is performed improperly, the assistant could be charged with
fraud
tertiary insurance
→ patients covered by a 3rd insurance policy
(AAPC) American Academy of Professional coders
→ A national membership organization that provides credentials, education, and coding
information to medical coders in all settings.
→ offers following certifications;
→ * Certified Professional Certifications
→ *Certified Professional Coder for Hospitals (CPC-H)
→ * Certified Professional Coder - Payer (CPC-P)
→ * Certified Inpatient Coder (CIC)
(AHIMA) American Health Information Management Association
→ a network of physicians with independent practices. they don't practice in the same
facility but are considered part of one network
(EPO) Exclusive Provider ORganization
→ combines features of an HMO & PPO. Will not reimburse patients for services
obtained outside the HMO network, physicians are reimbursed based on a fee-for-
service system instead of capitation
GroupModel
→ The HMO contracts with a multi-specialty group of physicians. these physicians usually
practice in the same facility like a hospital or group office
Staff Model
→ HMO will hire a group of physicians and pay them salary wages. This is, in effect, their
reimbursement for treating patients. May receive bonuses based on cost savings or #
of patients
High Deductible Health Plan (HDHP)
→ HMO, PPO, POS plans can have a high deductible options. this means that the
managed care plans are the same, except for the premiums are lowered in exchange
for a high deductible on the plan
Managed Care Organization (MCO)
→ focus on cutting costs, so there are more policies and procedures in place than with a
fee for service plan
Referrels
→ urgent referral can take up to 24 hours, stat refferal can be approved immediately
by phone
Watch Dog Organizations
1|Page| GradeA+ | 2 0 0 2 5
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller TestTrackers. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
