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Medical Insurance Billing Ch. 1
Healthcare Common Procedure Coding System
Procedures items done or given to the patient
Current Procedural Terminology
Where procedure codes come from
American Academy of Professional Coders
National association or organization that certifies coders
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.
American Health Information Management Association
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)
(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
a notice sent by the insurance company that contains payment information about a claim
Review health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider. (The Collector)
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.
prior approval for treatment by specialists and documentation of post treatment reports. (does not guarantee payment only authorization on treatment)
universal codees that can be used anywhere
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
Protects business assets and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising
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)
Explanation Of Benefits
A report detailing the results of processing a claim
How a claim is processed.
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?
The mutual exchange of data between provider and payer is called electronic?
The process of assigning diagnoses, procedures and services using numeric and alphanumeric characters is called?
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?
Medical malpractice insurance is a type of ? insurance
Which mandates workers compensation insurance to cover employees and their dependents against injury and edeath occurring the course of employment?
The American Medical Billing Association offers which cerficication?
Certified Medical Reimbursement Specialist