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The difference between the summarized income RATE and the summarized cost rate over a given valuation PERIOD is the Actuarial BALANCE.

The difference between the summarized income rate and the summarized cost rate over a given valuation period is the Actuarial Balance.

The BILLER MAY not be ABLE to CONTACT the PHYSICIAN

The biller may not be able to contact the physician

CIVILIAN HEALTH and Medical PROGRAM of the Uniformed SERVICES(CHAMPUS).

Civilian Health and Medical Program of the Uniformed Services(CHAMPUS).

A 3-digit number used on hospital bills to tell the INSURER where the patient was when they RECEIVED treatment, or what TYPE of ITEM a patient received, is the REVENUE Code.

A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the Revenue Code.

Medical CARE, other than those provided by the PHYSICIAN or HOSPITAL, which are RELATED to a PATIENT’s care, are called Ancillary care.

Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called Ancillary care.

PART C

Part C

10

10

UB04

UB04

FOUR NUMERIC DIGITS

Four numeric digits

They are USED to ADD more INFORMATION about a CPT CODE

They are used to add more information about a CPT code

PLACE of SERVICE

Place of Service

USUAL, CUSTOMARY, or REASONABLE

Usual, customary, or reasonable

An INDIVIDUAL who is COVERED under PARTS A and B.

An individual who is covered under Parts A and B.

ASSIGNMENT of BENEFITS

Assignment of Benefits

The ICD-9-CM CODING classification to identify health CARE for reasons other than INJURY or illness is know as V-code.

The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is know as V-code.

An ILLEGAL practice of assigning an ICD-9 diagnosis CODE that does not agree with the PATIENT records for the purpose of increasing the reimbursement from the insurance PAYOR is called Upcoding.

An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called Upcoding.

INTERMEDIARY between PROVIDER and INSURANCE

Intermediary between provider and insurance

FEDERAL TAX IDENTIFICATION NUMBER

Federal Tax Identification Number

PART D

Part D

ADT

ADT

HCFA1500

HCFA1500

To alert a patient that Medicare MAY DENY PAYMENT for a SPECIFIC procedure or treatment.

To alert a patient that Medicare may deny payment for a specific procedure or treatment.

EXPLANATION of BENEFITS

Explanation of Benefits

A SYSTEM that pays PHYSICIANS and nurses a SET AMOUNT per enrolled patient assigned to them.

A system that pays physicians and nurses a set amount per enrolled patient assigned to them.

Fee-for-Service

Fee-for-Service

The above STATMENT is TRUE.

The above statment is True.

DME

DME

YES, a physician uses an open-panel HMO, can they see non-HMO PATIENTS.

Yes, a physician uses an open-panel HMO, can they see non-HMO patients.

January

January

Medicare

Medicare

Transition

Transition

Balanced

Balanced

HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT

Health Insurance Portability Accountability Act

True

True

It checks BILLS for ERRORS then TRANSMITS them to the INSURANCE COMPANY

It checks bills for errors then transmits them to the insurance company

The PROCEDURES PERFORMED by a PHYSICIAN or a PRACTITIONER

The procedures performed by a physician or a practitioner

The federal law that allows a WORKER to continue to purchase EMPLOYER paid health insurance for up to 18 months if they lose their job or your COVERAGE is otherwise terminated is KNOWN as COBRA.

The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as COBRA.

COORDINATION of BENEFITS

Coordination of Benefits

Premium

Premium

HIPAA

HIPAA

The PLACE of SERVICE where SERVICES were RENDERED.

The place of service where services were rendered.

True

True

The date the insurance policy is set to BEGIN or when benefits or COVERED SERVICES are allowed is most COMMONLY known as the Effective date.

The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the Effective date.

referral

referral

INSURANCE AVAILABLE to INDIVIDUALS after they BECOME UNEMPLOYED

Insurance available to individuals after they become unemployed

The AMOUNT PAID for an INSURANCE POLICY

The amount paid for an insurance policy

Heart

Heart

DIAGNOSIS CODE

Diagnosis code

Co-pay

Co-pay

Yes.A co-payment an out of POCKET EXPENSE.

Yes.A co-payment an out of pocket expense.