Practice Issues Final Review
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What does HIPAA stand for?
Health Insurance Portability and Accountability Act
This type of insurance is obtained through your job.
This type of insurance is for Automobile accidents.
This type of insurance is for Disability / Injury on the job.
This type of insurance is form the government for ages 65 and older.
This type of insurance is from the government for lower income persons.
This term refers to a small amount of money to be paid at the time of visit.
This term refers the remaining percentage amount of the medical bill not covered by the insurance company.
This term refers a set amount of money that must be spent on medical services befroe the insurance company will begin reimbursing any amount.
This term refers to an extension on a patient's policy that must be there for Acupuncture coverage.
This term refers to any healthcare professional that provides healthcare to a patient.
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
What does CPT stand for?
- Current Procedural Terminology (Procedure Codes)
- Examples of CPT codes:
- Evaluation & Management
- *Acupuncture is under CPT's (Physical Medicine & Rehabilitation)
- *Owned by American Medical Association (AMA)
- *'There is no guarantee of payment when using these codes
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)
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)
What are the codes for Evaluation & Managemant?
- 99201-99205 (10-40, 60 mins, respectively)
- 99211-99215 (10-50 mins, respectively)
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)
What are other commonly used CPT codes?
- 97124: Massage
- 97140: Myofacial Release
- 97026: Infrared
- 97010: Heat & Cold packs
- 97016: Vasoneumatic Device (cupping)
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
What does HICF stand for?
- Health Insurance Claim Form
- *this is the main form sent to insurance companies
What does Accept Assignment mean (HICF 1500-Box 27)?
- If Yes: check comes to you
- If No: check goes to patient
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
Which insurer does not cover acupuncture at the time?
What does NCCAOM stand for?
National Certification Commision for Acupuncture and Oriental Medicine
Upon successful completion of the NCCAOM Examination on Acupuncture, a person would earn the title of what?
Diplomate of Acupuncture
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
Upon successful completion of the NCCAOM Examination, you are considered to be what?
You must Recertify with the NCCAOM every___ years.
Anyone who does not Recertify within the appropriate time frame is considered what?
In order to Recertify, you must have accumulated how many points?
60 PDA (Professional Development Activity) Points
A person who does not Recertify may register to be Inactive and remain Inactive for how long?
If a person's status becomes Expired, they may become permanantly Terminated within a period of how many years (as of 2013)?
Practitioners wishing to combine an Acupuncture Certification with an Herbal Certification are going to obtain the title of what?
To help Certified Practitioners in their practices, NCCAOM has begun to offer a what?
- Website package
- Marketing and Lobbying courses
What brochures are available from NCCAOM?
- Chinese Herbology
- Asian Bodywork Therapy
Is there a special code for NYCTCM for NCCAOM application material?
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