Practice Issues Final Review

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son850
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176503
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Practice Issues Final Review
Updated:
2012-11-15 16:32:09
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Biomedicine
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Biomedicine
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  1. What does HIPAA stand for?
    Health Insurance Portability and Accountability Act
  2. This type of insurance is obtained through your job.
    Major Medical
  3. This type of insurance is for Automobile accidents.
    No Fault
  4. This type of insurance is for Disability / Injury on the job.
    Worker's Compensation
  5. This type of insurance is form the government for ages 65 and older.
    Medicare
  6. This type of insurance is from the government for lower income persons.
    Medicaid
  7. This term refers to a small amount of money to be paid at the time of visit.
    Co-Payment
  8. This term refers the remaining percentage amount of the medical bill not covered by the insurance company.
    Co-Insurance
  9. This term refers a set amount of money that must be spent on medical services befroe the insurance company will begin reimbursing any amount.
    Deductible
  10. This term refers to an extension on a patient's policy that must be there for Acupuncture coverage.
    Rider
  11. This term refers to any healthcare professional that provides healthcare to a patient.
    Provider
  12. There are two types of providers, what are the differences?
    • In Network:
    • Signed contract with insurance companies
    • Obligated to that contract
    • Directory Listing
    • Often no deductibles
    • Pays less than Out of Network
    • No balance billing
    • Out of Network:
    • No contract
    • No obligations
    • Balance billing allowed
    • Pays more than In Network
    • No directory listing
    • Always deductibles
  13. What does CPT stand for?
    • Current Procedural Terminology (Procedure Codes)
    • Examples of CPT codes:
    • Unit
    • Acupuncture
    • Evaluation & Management
    • Modifiers
    • Other
    • *Acupuncture is under CPT's (Physical Medicine & Rehabilitation)
    • *Owned by American Medical Association (AMA)
    • *'There is no guarantee of payment when using these codes
  14. What are the Unit Codes for Regular Acupuncture?
    • 97810 - 1 unit (first 15 mintues)
    • 97811 - 1 or more units (additional 15 minutes after first unit)
  15. What are the Unit Codes for Electric Acupuncture?
    • 97813 - 1 unit (first 15 mins)
    • 97814 - 1 or more units (additional 15 mins after the first unit)
  16. What are the codes for Evaluation & Managemant?
    • 99201-99205 (10-40, 60 mins, respectively)
    • 99211-99215 (10-50 mins, respectively)
  17. What is modifier "25"?
    • Separates Exam from Treatment
    • Tells insurance that exam in not part of Acupuncture codes
    • (i.e. 99203-25 -- 30 min exam)
  18. What are other commonly used CPT codes?
    • 97124: Massage
    • 97140: Myofacial Release
    • 97026: Infrared
    • 97010: Heat & Cold packs
    • 97016: Vasoneumatic Device (cupping)
  19. What does ICD stand for?
    • International Classification of Diseases (Diagnosis Codes)
    • "Pain" is acceptable but specificity if best
    • Additional digit give specificity:
    • 719: joint disorder
    • 719.0: effusion of joint
    • 719.04: effusion of joint, Hand
    • *digits are important
  20. What does HICF stand for?
    • Health Insurance Claim Form
    • *this is the main form sent to insurance companies
  21. What does Accept Assignment mean (HICF 1500-Box 27)?
    • If Yes: check comes to you
    • If No: check goes to patient
  22. When seeing a patient, the practitioner who is not a contracted provider with the insurer can settle the payment by which methods?
    • Let the patient pay for the treatment, and give the patient an invoice
    • Send the bill to the insurer for the patient, but let the patient pay for the treatment
    • Send the bill to the insurer and wait for payment from the insurer
  23. Which insurer does not cover acupuncture at the time?
    Medicare
  24. What does NCCAOM stand for?
    National Certification Commision for Acupuncture and Oriental Medicine
  25. Upon successful completion of the NCCAOM Examination on Acupuncture, a person would earn the title of what?
    Diplomate of Acupuncture
  26. One of the benefits of remaining active in NCCAOM Status after successful examination is achieved is what?
    • You are listed in their directory of practitioners for your title and receive E Newsletters
    • They send verification of you status to third party payors for free
    • There are reduced fees for exam results, certification verification, etc
  27. Upon successful completion of the NCCAOM Examination, you are considered to be what?
    Active Status
  28. You must Recertify with the NCCAOM every___ years.
    4 Years
  29. Anyone who does not Recertify within the appropriate time frame is considered what?
    Expired
  30. In order to Recertify, you must have accumulated how many points?
    60 PDA (Professional Development Activity) Points
  31. A person who does not Recertify may register to be Inactive and remain Inactive for how long?
    2 Years
  32. If a person's status becomes Expired, they may become permanantly Terminated within a period of how many years (as of 2013)?
    3 Years
  33. Practitioners wishing to combine an Acupuncture Certification with an Herbal Certification are going to obtain the title of what?
    Oriental Medicine
  34. To help Certified Practitioners in their practices, NCCAOM has begun to offer a what?
    • Website package
    • Marketing and Lobbying courses
  35. What brochures are available from NCCAOM?
    • Acupuncture
    • Chinese Herbology
    • Asian Bodywork Therapy
  36. Is there a special code for NYCTCM for NCCAOM application material?
    • Yes
    • NCT 00092

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