HC21 Insurance & Coding Module Questions And Answers Latest Updates
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Course
HC21 Insurance & Coding Module
Institution
HC21 Insurance & Coding Module
TRICARE - ️️abbreviation for triple option care was formerly called the civilian
Health and Medical program for uniformed services (Champus). Still performs same
basic functions
The Physician's Current Procedural Terminology (CPT) manual provides - ️️a
medical code set that is used to r...
HC21 Insurance & Coding Module
TRICARE - ✔️✔️abbreviation for triple option care was formerly called the civilian
Health and Medical program for uniformed services (Champus). Still performs same
basic functions
The Physician's Current Procedural Terminology (CPT) manual provides - ✔️✔️a
medical code set that is used to report medical, surgical, and diagnostic procedures and
services to entities such as physicians, health insurance companies and accreditation
organizations.
Staff Model - ✔️✔️HMO will hire a group of physicians and pay them salary wages.
This is, in effect, their reimbursement for treating patients. May receive bonuses based
on cost savings or # of patients
Claim - ✔️✔️a document sent to an insurance carrier demanding payment for services
provided to an insured patient or an insured beneficiary
correct coding - ✔️✔️is a legal issue. if coding is performed improperly, the assistant
could be charged with fraud
tertiary insurance - ✔️✔️patients covered by a 3rd insurance policy
(AHIMA) American Health Information Management Association - ✔️✔️* Certified
Coding Specialist (CCS)
* Certified Coding Associate (CCA)
*Certified Coding Specialist for Physicians (CCS-P)
(IPA) Independent Practice Association - ✔️✔️a network of physicians with
independent practices. they don't practice in the same facility but are considered part of
one network
(EPO) Exclusive Provider ORganization - ✔️✔️combines features of an HMO & PPO.
Will not reimburse patients for services obtained outside the HMO network, physicians
are reimbursed based on a fee-for-service system instead of capitation
GroupModel - ✔️✔️The HMO contracts with a multi-specialty group of physicians.
these physicians usually practice in the same facility like a hospital or group office
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