Exam (elaborations)
Medical Billing and Coding Certificate Exam 2024 Graded A+!!
- Course
- Institution
Medical Billing and Coding Certificate Exam 2024 Graded A+!!
[Show more]
Content preview
Name: Score:196 Multiple choice questions
Term 1 of 196
Preauthorization
Prescription drug coverage
Verify the patient's eligibility for insurance benefits.
determine pre authorization and referral requirements.
determine the primary payer if more than one insurance plan is in effect
Healthcare access, portability and renewability
Prior approval for treatment and procedures
Term 2 of 196
electrical activity
gastr/o
cardi/o
enter/o
electr/o
,Term 3 of 196
fiscal intermediary
bold-faced term located in the ICD-10-CM index; listed in alphabetical order with subterms
and qualifiers indented below each main term
A process required by some insurance carriers in which the provider must prove medical
necessity before performing a procedure.
an insurance company that bids for a contract with Centers of Medicare and Medicaid
services to handle the Medicare program in a specific area.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Term 4 of 196
sub-
lying on the back
under, below
visual examination
arthr/o
,Term 5 of 196
excludes 2
A primary care physician informs the patient and telephones to the referring physician that
the patient is being referred for an appointment.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Health coverage option includes part A & part b & operated by private insurance
companies that are approved by & under contract w medicare
Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
Term 6 of 196
Preferred Provider Organization (PPO)
preferred provider organization
Hybrid of HMO & PPO w/ greater flexibility on choosing specialists outside network w/
benefits still provided but @ higher co-pay.
group of healthcare providers that provide services to a specific group, often at a reduced
rate
individuals who qualify for the program
, Term 7 of 196
Direct referral
-how difficult is it for the provider to do the procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
authorization request form is completed and signed by the physician and handed to the
patient
family members covered by the insurance plan
also called the superbill; it is a listing of all the diagnosis, procedures and charges for a
patient visit
Term 8 of 196
Medicaid
Federal program that provides medical benefits for low-income persons.
Covered services (80%)
deductible, premiums, co-insurance (20%) non-covered services
Minimal diagnosis
Minimal risk
Minimal complexity of data
Definition 9 of 196
an electronic paper-based report of payment sent by the payer to the provider
fee schedule
assignment of benefits
encounter form
remittance advice
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 Aplusplus. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75057 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now