Medical Billing and Coding - week 1

Chapter 1
STUDY
PLAY
AAPC
American Academy of Professional Coders - offers 4 certification exams. CPCA (The Certified Professional Coder Apprentice), CPC-HA (Certified Professional Coder - Hospital Apprentice) , CPC (Certified Professional Coder), and CPC-H (Certified Professional Coder - Hospital)
AHIMA
American Health Information Management Association - supports 3 certification exams for coding specialists - CCA (Certificed Coding Associate), fulfills the need for an entry-level coding credential, CCS - (Certified Coding Specialist), demonstrates competence in ICD-9-CM and CPT Surgery coding, as well as in patient documentation and data integrity/quality issues, anatomy, physiology, and pharmacology, CCS-P (Certified Coding Specialist - Physician Based, demonstrates expertise in multispecialty CPt, ICD-9-CM, and HCPCS national (level II coding).
AMBA
American Medical Billing Association - offers the Certified Medical Reimbursent Specialist (CMRS) exam
bonding insurance
An insurance agreement that guarantees repayment for financial losses resulting from an employee's act or failure to act. It protects the financial operations of the employer.
CMS
Centers for Medicare and Medicaid Services - the administration agency within the federal Department of Health and Human Services.
coding
The process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the insurance claim. Two systems used are ICD-9CM and HCPCS.
CPT
Current Procedural Terminology
electronic claims processing
Send data in a standardized machine-readable format to an insurance company via disk, telephone modem or cable.
EDI
Electronic Data Interchange - The mutual exchange of data between the provider and the insurance company, and is often used in clearinghouses.
embezzle
steal
errors and omissions insurance
Provides protection from claims resulting in errors and omissions associated with professional services provided to clients as expected of a person in the contractor's profession.
ethics
The principles of right or good conduct, and rules that govern the conduct of members of a profession.
EOB
Explanation of benefits - A report that details the results of processing a claim.
HCPCS
Healthcare Common Procedure Coding System
health care provider
A physician or other health care practioner (e.g., physician's assistant).
health information technician
Manage patient health information and medical records, administer computer information systems, and code diagnoses and procedures for health care services provided to patients.
health insurance claim
Documentation submitted to an insurance plan requesting reimbursement for health care services provided.
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.
hold harmless clause
Patient is not responsible for paying what the insurance plan denies in the contract, the health care provider cannot collect the fees from the patient.
independent contractor
A person who performs services for another under an express or implied agreement and who is not subject to the others' control, or right to control, of the manner and means of performing the services.
ICD-9-CM
International Classification of Disease - 9th Revision, Clinical Modification
liability insurance
Protects business assets and covers the cost of lawsuits resulting from bodily injury (e.g., customer slips on wet floor), personal injury (e.g. slander or libel), and false advertising.
medical malpractice insurance
A type of liability insurance, which covers physicians and other health care professionals for liability as to claims arising from patient treatment.
medical necessity
Linking every procedure or service code reported on the claim to a condition code that justifies the necessity for performing that procedure or service.
national codes (level II codes)
Commonly referred to as HCPCS level II codes, which are published by CMS and include five-digit alphanumeric codes for procedures, services, and supplies that are not classified in CPT.
NEBA
National Electronic Billers Alliance
preauthorization
Prior approval for treatment of specialists and post-treatment reports.
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.
property insurance
Protects business contents against fire, theft, and other risks.
reimbursement specialist
Review health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider.
remittance advice (remit)
A notice sent by the insurance company that consists of payment information about a claim.
respondeat superior
Means that the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment.
scope of practice
Defines the profession, delineates qualifications and responsibilities, and clarifies supervision requirements.
workers' compensation insurance
Protection mandated by state law that covers employees and their dependents against injury and death occurring during the course of employment.