Name: Score:
196 Multiple choice questions
Term 1 of 196
Preauthorization
Prescription drug coverage
Verify the patient's eligibility for insurance benefits.
determine pre authorization and referral requirements.
determine the primary payer if more than one insurance plan is in effect
Healthcare access, portability and renewability
Prior approval for treatment and procedures
Term 2 of 196
electrical activity
gastr/o
cardi/o
enter/o
electr/o
,Term 3 of 196
fiscal intermediary
bold-faced term located in the ICD-10-CM index; listed in alphabetical order with subterms
and qualifiers indented below each main term
A process required by some insurance carriers in which the provider must prove medical
necessity before performing a procedure.
an insurance company that bids for a contract with Centers of Medicare and Medicaid
services to handle the Medicare program in a specific area.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Term 4 of 196
sub-
lying on the back
under, below
visual examination
arthr/o
,Term 5 of 196
excludes 2
A primary care physician informs the patient and telephones to the referring physician that
the patient is being referred for an appointment.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Health coverage option includes part A & part b & operated by private insurance
companies that are approved by & under contract w medicare
Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
Term 6 of 196
Preferred Provider Organization (PPO)
preferred provider organization
Hybrid of HMO & PPO w/ greater flexibility on choosing specialists outside network w/
benefits still provided but @ higher co-pay.
group of healthcare providers that provide services to a specific group, often at a reduced
rate
individuals who qualify for the program
, Term 7 of 196
Direct referral
-how difficult is it for the provider to do the procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
authorization request form is completed and signed by the physician and handed to the
patient
family members covered by the insurance plan
also called the superbill; it is a listing of all the diagnosis, procedures and charges for a
patient visit
Term 8 of 196
Medicaid
Federal program that provides medical benefits for low-income persons.
Covered services (80%)
deductible, premiums, co-insurance (20%) non-covered services
Minimal diagnosis
Minimal risk
Minimal complexity of data
Definition 9 of 196
an electronic paper-based report of payment sent by the payer to the provider
fee schedule
assignment of benefits
encounter form
remittance advice
196 Multiple choice questions
Term 1 of 196
Preauthorization
Prescription drug coverage
Verify the patient's eligibility for insurance benefits.
determine pre authorization and referral requirements.
determine the primary payer if more than one insurance plan is in effect
Healthcare access, portability and renewability
Prior approval for treatment and procedures
Term 2 of 196
electrical activity
gastr/o
cardi/o
enter/o
electr/o
,Term 3 of 196
fiscal intermediary
bold-faced term located in the ICD-10-CM index; listed in alphabetical order with subterms
and qualifiers indented below each main term
A process required by some insurance carriers in which the provider must prove medical
necessity before performing a procedure.
an insurance company that bids for a contract with Centers of Medicare and Medicaid
services to handle the Medicare program in a specific area.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Term 4 of 196
sub-
lying on the back
under, below
visual examination
arthr/o
,Term 5 of 196
excludes 2
A primary care physician informs the patient and telephones to the referring physician that
the patient is being referred for an appointment.
"Not included here" Note includes that the condition excluded is not part of the condition
represented by the code, but a patient might have both conditions.
Health coverage option includes part A & part b & operated by private insurance
companies that are approved by & under contract w medicare
Billing non-covered services
Billing over limit services
Upcoding
Downcoding
Billing without signatures
Using outdated codes
Term 6 of 196
Preferred Provider Organization (PPO)
preferred provider organization
Hybrid of HMO & PPO w/ greater flexibility on choosing specialists outside network w/
benefits still provided but @ higher co-pay.
group of healthcare providers that provide services to a specific group, often at a reduced
rate
individuals who qualify for the program
, Term 7 of 196
Direct referral
-how difficult is it for the provider to do the procedure
-how much office overhead is involved
-the relative risk the procedure presents to the patient and the provider
authorization request form is completed and signed by the physician and handed to the
patient
family members covered by the insurance plan
also called the superbill; it is a listing of all the diagnosis, procedures and charges for a
patient visit
Term 8 of 196
Medicaid
Federal program that provides medical benefits for low-income persons.
Covered services (80%)
deductible, premiums, co-insurance (20%) non-covered services
Minimal diagnosis
Minimal risk
Minimal complexity of data
Definition 9 of 196
an electronic paper-based report of payment sent by the payer to the provider
fee schedule
assignment of benefits
encounter form
remittance advice
