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HCPCS

Healthcare Common Procedure Coding System

Procedures items done or given to the patient

CPT

Current Procedural Terminology

Where procedure codes come from

AAPC

American Academy of Professional Coders

National association or organization that certifies coders

Bonding Insurance

An insurance agreement that guarantees repayment for financial losses resulting from an employees act or failure to act. It protects the financial operations of the employer.

AHIMA

American Health Information Management Association

Health Information

CMS

Centers for Medicare and Medicaid Services (formerly known HCFA Health care financing administration)

Administrative agency within the federal Department of Health & Human Services

Scope of Work

Defines the profession, delineates qualifications and responsibility, and clarifies supervision requirements.
(has to be within the realm of the physician practice)

Respondeat Superior

(let the master answer) The employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment

Remittance Advice

a notice sent by the insurance company that contains payment information about a claim

Reimbursement Specialist

Review health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider. (The Collector)

Property Insurance

protects business contents against fire, theft, and other risks.

Professional Liability Insurance

Provides protection from claims resulting from errors and omissions associated with professional services provided to clients as expected of a person in the contractor's profession.

Preauthorization

prior approval for treatment by specialists and documentation of post treatment reports. (does not guarantee payment only authorization on treatment)

National Codes

universal codees that can be used anywhere

Medical Necessity

involves linking every procedure or service code reported on the claim to an ICD-9-CM condition code that justififes the necessity for performing that procedure or service

Medical Malpractice Insurance

a type of liability insurance that covers physicians and other healthcare professionals for liability claims arising from patient treatment

Liability Insurance

Protects business assets and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising

ICD

international classification of diseases, coding system used to report diagnoses and reasons for encouters on physician office claim

Hold Harmless Clause

patient is not responsible for paying what the insurance company denies.

Health Insurance Specialist

Review health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider.

Health Information Technician

Handles the medical records

Health Insurance Claim

Documentation submitted to a third-party payer or government program requesting reimbursement for health care services provided.

Health Care Provider

A physician or other health care practitioner.
(The person that is providing care to the patient)

EOB

Explanation Of Benefits
A report detailing the results of processing a claim
How a claim is processed.

Embezzle

Steal

EDI

Electronic Data Interchange
Mutual exchange of date between the provider and Insurance company.
*The way the computers communicate

Workers Compensation Insurance

Protection mandated by state law that covers employees and their dependents against injury and death occurring during the course of employment.

The document submitted to the payer requesting reimbursement is called a(n)?

Health Insurance Claim

The centers for Medicare and Medicaid Services (CMS) was previously called the?

Health care Financing Administration

A Health care practitioner is also called a?

Provider

The mutual exchange of data between provider and payer is called electronic?

Data Interchange

The process of assigning diagnoses, procedures and services using numeric and alphanumeric characters is called?

Coding

If Health plan preauthorization requirements are not met by providers?

Payment of the claim is denied

Which coding system is used to report diagnosis and conditions on claims?

International Classification of Diseases (ICD)

The CPT coding system is published by the?

American Medical Association (AMA)

National codes are associated with?

HCPCS - Health Common Procedure Coding System

Which report is sent to the patient to detail the results of claims processing?

Explanation of Benefits (EOB)

A remittance advice contains?

Payment information about a claim

Which type of insurance guarantees repayment for financial losses resulting from employees act or failure to act?

Bonding

Medical malpractice insurance is a type of ? insurance

Liability

Which mandates workers compensation insurance to cover employees and their dependents against injury and edeath occurring the course of employment?

State

The American Medical Billing Association offers which cerficication?

Certified Medical Reimbursement Specialist

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