Like this study set? Create a free account to save it.

Sign up for an account

Already have a Quizlet account? .

Create an account

The concept that every procedure or service reported to a third-party payer must be linked to a condition that justifies that procedure or service is called medical...


The administrative agency responsible for establishing rules for Medicare claims processing is called the...

Centers for Medicare & Medicaid Services (CMS)

Documentation submitted to an insurance company requesting reimbursement for healthcare services provided is called a health insurance...


Which organization is responsible for administering the Certified Medical Reimbursement Specialist certification exam?


Which clause is implemented if the requirements associated with preauthorization of a claim prior to payment are not met?

Hold Harmless

Data published in the Occupational Outlook Handbook indicate the job opportunities for health insurance specialists will increase by what percentage?

9% to 17%

Patients with health insurance may require _______ (prior approval) for treatment by specialists & documentation of post-treatment reports.


The process of reporting diagnoses, procedures, & services as numeric & alphanumeric characters on an insurance claim is...


Which is another title for the health insurance specialist?

Reimbursement Specialist

If a patient is seen by a provider who orders a chest x-ray, which diagnosis should be linked with the procedure to prove medical necessity?

Shortness of Breath

The principles of right or good conduct are known as...


The notice sent by the insurance company to the provider, which contains payment information about a claim, is the...

Remittance Advice

When an individual chooses to perform services for another under an express or implied agreement & is not subject to the other's control, the individual is defined as a(n)...

Independent Contractor

Employers are generally considered liable for the actions & omissions of employees as performed & committed within the scope of their employment. This is known as...

Respondeat Superior

Third-party payer _______ review CMS-1500 claims to determine whether the charges are reasonable for payment.

Claims Examiners

Which type of insurance should be purchased by health insurance specialist independent contractors?

Errors & Omissions

ICD codes are assigned to _______ on outpatient & physician office claims.


A remittance advice contains...

Payment information about a claim

High blood pressure is an example of a...


According to the Occupational Outlook Handbook, which setting offers the fastest employment growth & majority of new jobs for health information technicians (including those who perform insurance specialist functions)?

Physician offices

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording