Question

1. Define and spell the key terms os presented in the glossary 2. Define terminology necessary to understand and code medical insurance com for 3. Describe how to use the most current procedural and diagnostic coding systems 4. Code a sample claim form. 5. Apply third-party guidelines 6. Recognize common errors in completing insurance claim forms. 7. Explain the difference between the CMS-1500 (02-12) and the UB-04 forms. 8. Compare processes for filing insurance claims both manually and electronically. 9. Discuss why claims follow-up is important to the ambulatory care setting 10. Discuss legal and ethical issues related to coding and insurance claims processing KEY TERMS assumptive coding bundled codes claim register CMS-1500 (02-12) Current Procedural Terminology (CPT) diagnosis down-code encounter form (superbill) explanation of benefits (EOB) Healthcare Common Procedure Coding System (HCPCS) ICD-10-PCS International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) International Classification of Diseases, 10th Revision Procedure Coding System (ICD-10-PCS) medical necessity modifiers morbidity mortality nomenclature systems point-of-service (POS) device symbols unbundling Uniform Bill 04 (UB-04) up-coding International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

I NEED ONLY NUMBER ONE 1 ASAP, THANK YOU!

Only define them not spell.

Answer 1

& Define the keus temy prevented in the glouary: & Assumptive caring : Assumptive coding is defined as a nappropliate asignment of codex based on assuming, ton a review of clinical evidence in the patient record, that the patient has certain diagnosix or Received certain procedurex /sewices even though the provider did not specifically document those diagnosis or procedurel serviceux. © Bundled codex - hurtig Each code Represendu a specific securice task, product , oo procedure supplied to a patient which they DE ill to & be poled to do by insurance or other payers some times salice must Alwars go together & when they do and are always billed together, they may be bundled in to one code known. as bundled Codex. chim Register CONDENS Register clerk that A claim Register Refer& to a maintained by a bankruptcy cart contårs a list of all of the proofs

Claim that have been filled with the bankruptcy court It will not include claims Listed by the debtor on its Schedules clerk, A bankruptcy court takes Judicial notice of the claims Register. xato to thrownpho t forme 1500 to users o ④ CMS claim SY Hoa 6% The CMS 1500 farm ix the standard claim form used by a non-institutional provider or supplier to bill medicare carriers se durable medical campment Regional carriers when a provider Onalities for a waveier a waiver from the administrative simplification complaince Act recurament for electronic submission of claims. @ curent procedural terminology & APUP boat a ako current procedural terminology is a Medical code set that is used to Repout a medical, surgical, & diagnostie procedure & services to Enfities such as physicians, health insurance companies & accrediation Organisating

© Diagnosix code A diagnosis code or a combination of letters lor numbers assigned to a particular diagnosix i symptom or procedure. 6 Down Code & us on ♡ Down code amigning a code for procedure or service Lower than that actually performed. Encountes forms zu e Encounter forms are a kay component in Accuurate billing Ee collections, They document Services Rendered by capturing the diagnosty & procedure codes which serve as the basis for billing & Recent of payment services © Explanation of benefits :- To An explanation of benefity in a statement Send by a health insurance company covered by Pindividualy explaining what medical treatments slow Sealices were pold for an their behalt. V nedol X2

Hopese Health care common procedure coding system it standardized code system necenany fazer medical providery to submit heath care claims to medicare or other health insurances in a Commistent and arderly manner. ICD-10-PCs 9- The internatinal clanification of breare 10th Revision, procedure coding system is a vis. cataloging sustem for procedural codes that track varioux health intervention taken by medical profeuional. ICD-9-CME for a Nitro tornatore hun stole ICD-9 cm in the official system of auraning codes to diagnosex & procedures anosiated with hospital utilization in the united Stalex. & in a clarification system for surgical i diagnostic & therapeutic procedures.

ICD-10-CM& International clarification of Divore, 10th Revision, clinical modification provided by the centers for coding in the system used by phunician & other and other health care providers to claufifus &e code all diagnosis, symptoms & procedurex Recorded in a conjunction with hospital care in united states ICD-10 - PCS Y cilice ICD-10 pcs Piya Us.cataloging system for procedural codes that tack various health enterventions taken by medical profeuionals The ICD- 10 pcs code set wed in patient El hospital selfing medical necerity & seuran toimmun Medical neceility Meary health care Seruices that a phyſician, exerising prudent Clinical sudgement , would provide to patient, medical neceuity ix united states Legal doctrine, Related to actiuhtrux which may be justified as a Reseanable, necenary, and appropriate based on a evidence – bared clinical standard of care.

o morbidity & o Morternity Refers to having a disease of a symptom of disease or to the amount of divare with in a population, morbidity also Relexy to medical problems caused by treatment @ mortality't do igar alhes Mortality Refers to the state of being mortal (destined to die) Pna medicine a terem also used for death sale Cor) number of deaths in Самбір ел Р. o nomenclature & bikset Po robi theo Nomenclature is defined as a syskm of names & teams used in a particular field of Studey or community. An example of nomenclature Ppy the Language of Sculpture tort porn 6 point of service device & Astritis point of serise deure of relating to, or being a health care insurance plans that allaus enrolles to Seek care from a physician affiliated with the service provided at a fixed co-payment of choose a non affiliated philician 4 pay 10

0 symboly :- The definition of Symbol of Something that stands for a Represents something Elge, an idea obiect or relationship. Symboly take the form of words, gestures, sounds, ideas or vinal image 6 are used to convery other ideas & beliefs on W unbundling a an bundling is a proces by which a Company with serveral difhent linex, or multiple procedue codey are filled for a group of procedurex That are covered by a single comprehensive code o unifoom bill Cub-04) The uniform siling ix form that standard claim from that any institutional provider can use for the briling & medical a mental health claunus Although developed centers by cars the form has become The Standard form used by all insurance Carvers.

w upcoding a Brottsing up coding ex radulent medical Billing on which a bill sent for health service & more expensive than et should have been based on the source that way performed up coded bil can be sent to any paused why medicad, medicare or The patient. whether Mad menone prilburg Please Rate the Answer *