CEHRS (PURPLE)

REVENUE CYCLE FINANCES

What should you provide when any payment is made by the patient?

Receipt

National Correct Coding Initiative (NCCI)

This is used by CMS to assist in controlling erroneous coding billed to Medicare and facilitate correct coding methods

Healthcare Common Procedure Coding System (HCPCS)

These codes are used to bill services, supplies, and products not included in the CPT manual

The NCCI recommends ______ software for procedures and outpatient services to ensure codes are reported accurately to avoid fraud

Outpatient Code Editor (OCE)

HCPCS codes are updated ______ time a year

4 times

_____ occurs when patients refer themselves and make their own arrangements to see the specialist

Self-referral

Procedures and services codes are divided into sections and has an associated value for reimbursement purposes. What category is this in the CPT coding book?

Category 1

RA is sent to the ______

Physician

_____ is an informal procedure used in the health insurance industry to help determine which plan is considered “primary” when children's are listed as dependents on more than one health plan

Birthday Rule

If a provider performs multiple procedures during an encounter, rank the procedures from what?

Major to Minor

What does CDT mean?

Current Dental Terminology (CDT)

Eligibility for Medicare beneficiaries can be verified in real time using the ______

HIPAA Eligibility Transaction System (HETS)

What may be generated from the financial or billing sections of the EHR

Patient Statements

According to whom, any claims denied under NCCI edits are not allowed to be billed to the patient

Medicare guidelines

ICD-10-CM

It consists of a maximum of seven alphanumeric characters

Never code by using the ______ only, you need to go to the tabular list for correct code

Index

______ is used when two codes are used for one diagnosis

code-first

Unlisted Codes

These codes are provided for each section of the CPT and are used when a service procedure is performed that does not have a corresponding code.

Guidelines

These are at the beginning of each section provide essential information for correct coding.

The ________ amount is generated by the provider

Billed Amount

When collecting payments from patients notify the patient of ______ and collecting at the time of service

Anticipated Charges

Current Procedural Terminology 4th ed. (CPT)

These codes are used to bill physician and professional services at clinics and outpatient organizations

Explanation of Benefits (EOB)

A statement that shows the patient how services provided were processed by the insurance carrier

What do you do when the provider receives an overpayment from the insurance company?

Document: Whom the refund was made, the date funds were returned and the method of refund

Preregistration

The process of entering the patients demographics and historical information into the EHR prior to visit

Preauthorization

The process of determining whether the third-party payer agrees that the requested service is medically necessary

Precertification

The process of determining whether a procedure or test is covered under the insurance card

How any sections does the ICD-10-CM have and name them?

1. Alphabetic Index to diseases and inquiries

2. Neoplasm Table

3. Table of drugs and chemicals

4. Index of External causes

5. Tabular list of diseases and injuries

Remittance Advice (RA)

A report from insurance carriers to a service provider that describes payments and how the amount was determined

_______ is a process when medical codes are assigned to patient medical chart throughout their stay at the hospital

Concurrent coding

The ____ codes are used for services or products for which there are no pre-existing codes and needs documentation for proof

Miscellaneous

Interoperability

The ability of computer systems or software to exchange and make use of information

In the electronic environment, all transaction are _____

Digital

When a patient arrives or leaves a medical office what is the money given to the front office called?

Co-payment

What does PCP mean?

Primary Care Provider

How many levels are in the healthcare common procedure coding system and what are the levels called?

2 levels

level 1: CPT

level 2: HCPCS

Who is responsible when paying deductibles, coinsurance amounts and copayments?

Patient

_______ is given when a provider informs a patient and requests the referring service provider to set up a patient appointment

Verbal Referral

These ______ codes allow billing and payment of services that are not covered by the current payment national codes.

Temporary National Codes

What is used for diagnostic coding in all settings

International classification of diseases, 10 revision, clinical modification ICD-10-CM

What is needed when you use an unlisted code to submit to the insurance carrier?

Supporting Documentation

The ______ amount is the amount that the insurance and provider agreed on which is considered contractional

Allowed Amount

_____ are two digits appended to the CPT codes it references?

Modifiers

What is a percentage of the allowed amount called when the patient pays it?

Coinsurance

What does ABN mean?

Advanced Beneficiary Notice

Deductible, coinsurance, and co-payment is whose responsibility?

Patient Responsibility

Medicaid

The insurance provides an online eligibility database that is managed by each individual state.

______ is an authorization request to determine medical neccessity

Formal referral

Out-of-pocket expenses

This is how much a patient has to pay for copay and co-insurance

What does the HCPCS national panel keep up to date in the HCPCS coding book.

Permanent National Codes

All _____ supplies and procedures are published by the American Dental Association in the HCPCS coding book

Dental

Who should you include when a template is being developed to ensure workflow need are met?

All staff

When should the provider expect payment from the insurance company?

4 to 12 weeks

Predetermination

The process of discovering the maximum amount the third-party payer will pay for a particular service.

Category 3

These are temporary code for emerging technology and new services and procedures and they also have value for reimbursement and purposes

What may be sent to the provider when additional documentation is necessary to clarify a diagnosis or a procedure that has been performed?

Physician Query

_____ codes are specific to medicare in the HCPCS coding book

G codes

________ codes are used to report services rendered by providers

Current Procedural Terminology (CPT)

Where can patients views personal billing and insurance information and sometimes track insurance payments, see if personal payments have been received and credited, and view outstanding balance

Patient Portal

Category 2

These codes are optional codes used to track performance and to document patient care episodes and care for reporting purposes only

What is used only for inpatient hospital procedure coding in the U.S?

International Classification of diseases, 10th revision, procedure coding system ICD-10-PCS

what is designed to eliminate lengthy searches for required diagnosis and procedure codes

Encoder Software

ICD-10-PCS

This coding book excludes the letters I and O because they could look like 1 and 0

Code first requires a specific sequencing order, with underlying condition listed before then _____ code

Manifestation

What increases productivity with an organization but are subject to errors based on documentation?

Computer-Assisted Coding

What are all processes that relate to claims and payment, or other ways of generating revenue?

Revenue Cycle

Out-of-network organization

An organization who does not agree with how much a service or procedure will cost

If Medicare denies payment for services or supplies that are usually covered, an ______ needs to be given to the patient

Advanced Beneficiary Notice (ABN)

Healthcare Common Procedure Coding System (HCPCS)

These codes start with a letter (A through V) followed by four numbers

What codes represent medication in the HCPCS book

J codes

Verification of insurance benefits and eligibility is normally initiated _______?

During patient registration or admission process

Who develops, maintains, and owns the copyright to the coding system “CPT”

American Medical Association (AMA)

What does ADA stand for?

American Dental Association

______ in the HCPCS code set are used when procedures and services need to be clarified. They are two characters either alphabetic or alphanumeric

Modifiers

______ is an authorization request form that is completed and signed by a provider and given directly to a patient

Direct Referral

In-network organization

An organization who agrees with how much a service or procedure will cost.

what is a specific amount due from the patient each year called?

Deductible

The PCP office is usually required to handle _______ requests?

Preauthorization

What is a point where two systems meet and interact?

Interface

Daysheet

A report that details 24-hour activity within the practice

Who accepts financial responsibility whenever Medicare does not pay for services rendered?

Beneficiary