Study Guide (Certified Medical Coding and Billing Specialist) – Flashcards
Unlock all answers in this set
Unlock answersquestion
UB04 form is used for
answer
Hospice, Ambulatory Surgery Centers, Home Health Care
question
patient confidentiality
answer
treating patient's medical information as private and not for publication
question
signing an Acknowledgement of Notice of Privacy Practice is accepting what
answer
HIPAA
question
form to authorize sharing of medical information
answer
medical release form
question
standard form used for medical billing
answer
CMS-1500
question
must appear on CMS 1500 form prior to submission
answer
birth date in 8 digit format, all caps
question
encounter form
answer
financial record source document to record treated diagnosis and services rendered to the patient during the current encounter. also called the superbill
question
where non allowed charges are recorded
answer
adjustment column
question
10 digit numeric identifier required in box 33A of CMS 1500
answer
National Provider Identifier (NPI)
question
CLIA - Clinical Laboratory Improvement Act
answer
quality standards for lab tests
question
most common reason for claim rejection
answer
incorrect or incomplete information
question
PICA pitch 10
answer
written CMS 1500 form
question
PICA pitch 12
answer
electronic CMS 1500 form
question
delinquent claim
answer
not paid within a certain amount of time
question
implied contract
answer
patient scheduling an appointment with a new provider
question
bullet/solid circle
answer
symbol used to indicate a new CPT code
question
plus sign (+)
answer
add on CPT code symbol
question
triangle
answer
new/revised code in HCPCS level 1
question
multiple, varying wound sizes
answer
add the sizes together
question
dependents of military personnel
answer
required to have military ID for TriCare insurance
question
used as first-listed diagnosis to indicate family history
answer
V-Code
question
diagnostic category code
answer
three digit code that covers a single disease or relative condition
question
standard medical code sets
answer
ICD-9-CM, HCPCS, CPT, HCPCS Level II
question
insurance claim register
answer
diary or ledger of submitted claims
question
appeal
answer
explains why claim should be re-considered for payment
question
offer Medigap
answer
private commercial insurance companies
question
hemodialysis
answer
found in medicine secion of CPT manual
question
payer of last resort
answer
Medicaid
question
Medicare Administrative Contractor (MAC)
answer
Third party that contracts with CMS (Centers for Medicare and Madicaid Services) to process claims and perform integrity tasks - accepts electronic claims
question
pending
answer
submitted for review not yet paid
question
co-payment
answer
cost sharing requirement for the insured to pay at the time of service
question
steps for coding 1st, 2nd, and 3rd degree burns
answer
depth, extent, agent (e-code). 3rd degree first
question
privacy officer
answer
protects patient health information
question
ICD-9 principle
answer
code signs and symptoms in absence of established diagnosis
question
classifications of neoplasms in table of neoplasms
answer
malignant, benighn, uncertain, un-specified, specific, in-situ (6)
question
form needed for medicare patient when services for diagnostic tests are not covered
answer
ABN (Advanced Beneficiary Notice)
question
valid ICD-9 principle
answer
code to the full number of digits required for that code or it is invalid
question
claim control number
answer
claim ID or DCN (document control number) assigned to each claim
question
time reporting
answer
guideline for anesthesiology, 24G on CMS 1500
question
developed and updates the CPT manual
answer
AMA (American Medical Association)
question
patient ledger account
answer
permanent record of all financial transactions between the practice and the patient
question
bull's eye
answer
CPT symbol for conscious moderate sedation
