MBC 110 final

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MBC 110 final
2013-08-08 13:17:05
Medical Billing Coding

final 110
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  1. MS
    Mitral Stenosis
  2. Fibrillation
    quivering or spontaneous contraction of individual muscle fibers
  3. Digitalis drugs
    strengthen the heart muscle, increase force velocity of a contraction. used in treatments of the heart
  4. Phon/o
  5. most common symptom of a heart attack
    dyspnea, shortness of breath
  6. Angin
    to choke
  7. HDL
    high-Density Lipoprotien
  8. primary function of muscles
    • movement
    • maintain posture
  9. ataxia
    lack of muscular coordination
  10. Trendelenburg positon, what is it used for?
    used to displace abnormal organs during surgery and in treating cardiovascular shock; body is supine on a bed that is tilted 45 angle with the head lower than the feet
  11. Dactylospasm
    medical term for cramp if a finger or a toe
  12. DTR
    Deep Tendon Refelxes
  13. ulcerative colitis
    disease that causes inflammation and ulcers in the lining of the large intestine
  14. gastrointestinal series
    fluoroscopic examination of the esophagus, stomach, and small intestine in which barium is given orally and is observed as it flows through the GI system
  15. dys-
    bad, painful, difficult, abnormal
  16. ac
    before meals
  17. colectomy
    surgical excision of part of the colon
  18. BE
    below elbow, barium enema
  19. absorption
    porcess by which nutrient material is tranferred from the GI tract into the blood stream or lymph
  20. what is the tongue made of?
    skeletal muscle and is covered with mucous membrane
  21. Sims position
    used in exmaination of the rectum
  22. aponeurosis
    a strong, flaty sheet of fibrous connective tissue that serves as a tendon to attach muscle to bones
  23. Tract
    group of nerve fibers in the CNS that hav the same origin, function, and temrination
  24. JRA
    Juvenile Rheumatoid Arthritis
  25. SPECT
    Single Photon Emission Computed Tomography
  26. Foramen
    opening in the bone for blood vessel, ligaments, and nerves
  27. Inversion
    turning inward
  28. kyphosis
    condition in whihc the normal throacic curvature becomes exagerated, producing a "humpback"
  29. name the four spinal curves and give the number of vertabrae in each
    • Cervical 1-7
    • Throacic 1-12
    • Lumbar 1-5
    • Sacral 1-5
  30. -ion
  31. gynecoid pelvis
    type of pelvis characterisics of the normal female and is ideal pelvic type for childbirth
  32. what is the medical office speacilist responsible for?
    • entering all dempgraphic information
    • post charges
    • payments
    • adjustments
  33. allowed amount
    maxiumum amount an insurance payer considers reasonable for medical services
  34. where would the name of the physician rendering care would be found
    encounter form
  35. where will the fee the provider charges be found
    encounter form
  36. where sould the office speacilist find the ICD-9 code
  37. what sould be batched together at the end of the day
    all monies recieved, tally all cash on hand and compare your totals with the patient day sheet
  38. where can patient information payment method and visit onformation visit be found
    encounter form
  39. batching out
    when you calculate all monies recieved, tally all cash on hand and compare your totals with the patient day sheet report totals
  40. injury without disability
    an employee who in ijured on the job, requires treatment, and is able to return to work within several days. expenses will be covered by WC only if injury in compensable
  41. if you failed to observe safety procedures could you still get WC
  42. four types of WC benefits
    • Medical
    • Income
    • Death
    • Burial
  43. is WC claim info subject to same confidentiality
  44. where would vital signs be recorded in the medical record
    SOAP notes in the Objective
  45. how should the MOS answer patients questions about claims
    • voulunteer to explain
    • use simple language
    • explain more than once if necessary
    • ask if they understand
    • respect
  46. if a procedure is not documented ________
    DO NOT BILL IT! (x2)
  47. difference between subjective and objective
    subjective is the patients past health status such as E&M history and history of present illness, while objective is the patients present health status, such as vitals, BP, height, and weight
  48. why is documentation important?
    to make sure all paient information is correct and and appropitate to the care given
  49. if an injured worker is impaired at 8%, how long would he recieve impairment income
    24 weeks
  50. examples of compensable injuries
    • falls in the parking lot
    • injuries/accidents that occur on the employees "personal time"
    • back injuries due to requred heavy lifting or fall
    • repetitive motion/stress injuries, carpal tunnel
  51. when do medical benefits begin for an injured worker
    immediately after the injury or illness; but they must choose a phyisician that is apporved on the WC list
  52. all communication with a designated doctor about WC injury must be handled directly with 
    the WC office handiling the claim
  53. how do most practices learn about appeals policies of the major plans they work with?
  54. what should the MOS do when a claim is denied for lack of preauthorization?
    review the contract. if authorization was not taken, appeal the claim. is authorization was takern, call the carrier to give the authroization  number
  55. What are the three cost elements considered in developingj the RBRVS
    • Provider's Work
    • Practice Expenses
    • Professional Liability Insurance
  56. what is the first step for the MOS before submitting a medical claim?
    obtain complete and correct patient information form
  57. Geographic Practice Cost Index (GPCI)
    a adjustment that accounts for geographic variations in the costs of practicing medicine in different areas of the country; designed to represent costs coupled with physician work, practice and malpractice expenses in a Medicare area compared to the national average relative costs
  58. MCF
    Medicare Conversion Factor; determined by CMS, it is a national value that convertys the totla relative units into a payment amount to reimburse providers for medical services
  59. turn around time
    length of time an insurance carrier takes to process a claim from the time it is recieved in their office
  60. medically necessary
    services or supplies that are required to properly treat a specific medical group
  61. 75% of the physician work under RBRVS is adjusted by geographic earnings
  62. when does SCHIP coverage begin for eligble individuals
    as early as the third month prior to application
  63. what is the goal of SCHIP
    to provide more federal funds for styates to expand Medicaid eligibilty to include a greater number of children who are currently uninsured
  64. Tricare is available to beneficiaries throughout the US and overseas
  65. penalties or intrest can be charged to the benficiary due to Tricares faliure to pay
    health insurance of the uniformed services for qualified families of military personnel
  67. PCM - under TRICARE
    coordinates and managed patients care, may be a single military or civilian provider or a group of providers, all referrals must be assigned by the PCM to avoid POS charges
  68. what are advantages of submitting TRICARE claims electronically  
    • Direct transmissions to PGBA
    • An immediate online claims acceptance or rejection report
    • Time-saving online correction of claims prior to being sent to PGBA
    • Processed and paid in lesser time
  69. are prescription drug benefits included in Tricare Senior Prime
  70. under Tricare Prime who pays a copay to see civilian providers
    retired service members
  71. an allowed amount includes the amount that will be paid by
    the patient or the insurance to the provider
  72. PGBA EMployees do not provde information to parents of minors when services are related to drug abuse
  73. Medicare Part C plans are offered through
    managed care health care programs
  74. Medicare Advantage Plan
    Medicare Part C; has both Part A & B coverage as well as other benefits not offered by traditional Medicare programs
  75. what must be done when Medicare is the secondary payer
    the MOS must complete the required form locators fields in the computer and the claim will be processed without any attachment
  76. what was the deductible for Medicare Part A in 2007 
  77. TANF
    Temporary Assistance for Needy Families; a time-limited (5 years) cash assitance benefit for families that qualify based on the state income or proverty level
  78. when are legal residents eligble for Medicaid
    • Categorically needy
    • Medically needy
    • Special Groups
    • (5 years)
  79. how long  do you have to submit an inpatient claim to a Medicaid
    they must be recieved by Medicaid within 95 days form the discharge date
  80. who is billed for the services if no authorization was obtained
    if no authorization was obtained, then you must write a letter of appeals because it will not be paid
  81. what Medicaid services are eligble for federal matching funds
    Not acupuncture
  82. what are two managed care models recognized by Medicaid
    • HMO
    • Primary Care Case Management (PCCM)
  83. why is there not a standardized superbill
    each physician office deals with different speacilities that deal with different codes
  84. place of service code used in locator 24b
    not operating services
  85. dirty claim
    a claim that is incorrect or missing information
  86. the CMS 1500 is mandatory for all Medicare claims
    flase; it is used for Part B; and UB-04 is for Part A
  87. COB
    Coordination Of Benefits; when patient has more than one more insirance company, the insurnce companies work together to coordinate the insurance benfits so that the maximum payemtn does not exceed 100% of the charge  
  88. Superbill
    document that contains ICD-9 and CPT codes the office routinely uses
  89. what are the options in locator 1 on the CMS 1500
    • Medicare
    • Medicaid
    • FECA Black Lung  
    • Group Health Plan  
    • Other
  90. What does a patient information for typically include?
    • Name
    • Birth
    • Sex
    • Address
    • Phone #
    • Inurance Information
  91. since 1996 what claim form is used in hospitals
  92. a patient whose condition permits adequate time to schedule services is considered
    elective admission
  93. elective admission
    a patient whose condition permits adequate time to schedule services
  94. PPS
    Prospective Payment System;  categorizes patients who are medically related with resect to diagnosis and treatment and who statistically similar in terms of their length of hospital stay
  95. what is required in the FL 1 of the UB-04
    patient information
  96. condition codes are used to describe
    specific conditions pertaning to the patients admission
  97. fraud
    an intentional decption or misrepresentation that an individual knows, to be false but still documents it
  98. the premium for Part B Medicare in 2006 was
  99. What criteria must be met by Medicare for a service to be considered medically necessary
    • Procedure matches the diagnosis
    • Not an elective procedure
    • Not experimental
    • Essential treatment
    • Delivered at the most appropiate level
  100. what information is included on the Medicare beneficiaries card
    • Exact name
    • Claim number - include all numbers and letters
    • Type of coverage
    • Effective dates of coverage for Part A & Part B