test #6

HCPCS

Allows the billing out of non medical services by MD (hospital bed, walker, and vaccines). It comes from Medicare (CMS) and is alphanumerical.

Upcoding

MD bills for more than what they did. Billing for a more expensive procedure than what was performed. Illegal and a fraud.

• ex. Patient is given a bandaid for a blister on a finger. The provider bills for draining the blister, a more expensive procedure.

Downcoding

MD bills for less than what the did. The provider does drain the blister, but bills for an office visit. The provider is entitled to bill for surgery, but chooses not to. It is a loss of money to the practice, and considered a fraud. Insurance companies can downcode a claim if the CPT and ICD documentation do not support eachother.

NFS

Non Sufficient Funds

New patient gets E/M Code. What is it?

99202-99205

Established patient gets E/M code. Which one?

99211-99215

The higher the number within the E/M category …..

The more the provider did and the more the provider should be paid

Numbers greater than 99215

Took place outside the office- hospital, long term care facility, in the street

How many digits for icd10?

Accounting

Taking of the bookkeeping numbers and making financial decisions.

Who writes down the procedure?

Provider

Amount of numbers in the code

7

Reconciling

A process to make sure you and the bank agree on the balance in the checking account. The bank statement and check register are used to complete the process. Reconciliation should be done every 30 days.

Accounts receivable (A/R)

Money owed to the provider. Most are owed by insurance

Accounts payable (A/P)

Money owed by the provider. Rent, utilities, and insurances are the most common. Recurring expenses

Payment

Agent

List of medical procedures performed in the office

Cashier check

A check of the institution.

Certified check

An individuals check that the bank withdraws and holds the funds

Electronic check

Payment is made via the internet. It is used today for recurring payments, such as rent, mortgage, car, and insurance

Postdated check

It is dated after the day it is given. Checks won’t be honored by the banking system before the date written on them.

Stale check

A check by law is only good for 6 months from the date written on it. A check can be made good for less than 6 months by writing on it- good for 60 days or void after 90 days

Check register

Tracks bank account transaction. Record of $ that has been spent. Shows the check number, person to whom check is paid, amount of the check, date, and balance.

Bank statement

Record of an account sent to the account holder usually on a monthly basis

Double entry system

Accounting method of recording transactions that provides an equality of debits and credits. Provides two sided effect of each transaction being recorded in the appropriate accounts

Single entry system

Accounting method in which each financial transaction is recorded only once in account books similar to checkbook register. Journal for each transaction is recorded in one column

What type of system is ____ (first page)

Double system

Established pt

New pt

ICD

International classification of diseases is the diagnosis code. What do I think is wrong with you? The reason for care.

• ICD and CPT code must agree.

• You get a flu shot → CPT code = the injection

• You have the flu or need prevention → ICD code = the reason/condition

Credit card

A loan for 26 days

Debit cards

Funds are withdrawn immediately

Savings account

Bank account that pays interest

Checking account

Called the operating account, pay the bills from

Online banking, atms, and mobile banking

No need to go to the physical branch

CPT

Current procedural terminology. What did the provider do for the patient? 5 digits long with the possibility of a two digit modifier. Designated as levels of service to the pt (higher level of service, more MD can be paid bc they did more)

Bundling

Unbundling

When the insurance company has put certain procedure together and wants them billed as one claim. If provider bills PRE, OP, and POST separately, they are guilty of unbundling. Insurance pays for most expensive part of the claim (operation). Unbundling can subject the provider to a fraud suit under the false claims act.

Purpose of ICD code

To track mortality and morbidly

What do you call a check that’s been post dated

Stale checks

Bank reconciliation

The process of verifying that the amounts on the bank statement are consistent with the amounts in the check register.

TILA

4 installments

Write offs

Money the practice will never collect

Deposit slip

List all the coins, bills, and checks going into the account

Expenditure

Outgoing payment for goods and services

Petty cash

Small amount of $ used for miscellaneous purchases or reimbursement (gas, parking, tolls)

Bookkeeping

Keeps track of all financial transactions