question

Actions inconsistent with accepted, sound medical business or fiscal practice

answer

Abuse

question

Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.)

answer

Accept Assignment

question

The amount owed to a business for services or goods provided.

answer

Accounts Receivable

question

Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients.

answer

Accounts Receivable Aging Report

question

Assists Providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services.

answer

Accounts Receivable Management

question

Voluntary Process that a healthcare facility or organization (e.g. hospital or manged care plan) undergoes to demonstarte that it has met standards beyond those required by law.

answer

Accreditation

question

Judicial dispuite resolution process in which an appeals board makes a final determination.

answer

Adjudication

question

payment correction resulting in additional payment(s) to the provider.

answer

Adjusted Claim

question

Document that acknowledges patient responsiblity for payment if Medicare denies the cliam.

answer

Advance Beneficiary Notice (ABN)

question

Also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.

answer

Adverse Effect

question

Also called adverse effect; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.

answer

Adverse Reaction

question

Covering members who are sicker then the general population.

answer

Adverse Selection

question

see limiting charge; maximum fee a physician may charge.

answer

Allowable Charge

question

The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.

answer

Allowed Charge

question

DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.

answer

All Patient Diagnosis-Related Group (AP-DRG)

question

Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded originial DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.

answer

All Patient Refined Diagnosis-Related Group (ARP-DRG)

question

Payment system for ambulance services provided to Medicare Beneficiaries.

answer

Ambulance Fee Schedule

question

Prospective payment system used to calculate reimbursement for outpatient care according to similar clinical characteristics and in terms of resources required.

answer

Ambulatory Payment Classification (APC)

question

State Licensed Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare Claims.

answer

Ambulatory Surgical Center (ASC)

question

Predetermined amount for which ASC services are reimbursed, at 80 percent after adjument for regional wage variations.

answer

Ambulatory Surgical Center Payment Rate

question

Legislation that allowed federally qualified HMOs to permit members to occasionally use non HMO physicians and be partially reimbursed.

answer

Amendment to the HMO Act of 1973

question

Professional association established to provide a national certification and credentialing process, to support the national and local membership by providing educational products and opportunities to network, and to increase and promote national recognition and awareness of professional coding.

answer

American Academy of Processional Coders (AAPC)

question

Enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants' right to practice.

answer

American Association of Medical Assistants (AAMA)

question

Claims validation table (as in ANSI ASC X12 837)

answer

837

question

American Association of Medical Assistants

answer

AAMA

question

Advance Beneficiary Notice

answer

ABN

question

Americans with Disabilties Act

answer

ADA

question

American Hospital Association

answer

AHA

question

American Hospital Formulary Service

answer

AHFS

question

American Health Information Management Association

answer

AHIMA

question

American Medical Association

answer

AMA

question

American National Standards Institute

answer

ANSI

question

Ambulatory Payment Classification

answer

APC

question

All Patient Diagnosis-Related Group

answer

AP-DRG

question

All Patient Refined Diagnosis-Related Group

answer

ARP-DRG

question

Accredited Standards Committee

answer

ASC

question

Ambulatory Surgical Center

answer

ASC

question

Blue Cross

answer

BC

question

Beneficary Counseling and Assistance Coordinator

answer

BCAC

question

Blue Cross Blue Shield

answer

BCBS

question

Blue Cross Blue Shield Association

answer

BCBSA

question

Blue Shield

answer

BS

question

Beneficiary Services Representative

answer

BSR

question

Cancer or Carcinoma

answer

CA

question

Common Access Card

answer

CAC

question

Computer Assisted Coding

answer

CAC

question

Computerized Axial Tomography

answer

CAT

question

Certified Coding Specialist

answer

CCS

question

Clinical Data Abstracting Center

answer

CDAC

question

Consumer Directed Health Plan

answer

CDHP

question

California Department of Health Services

answer

CDHS

question

Current Dental Terminology

answer

CDT

question

Comprehensive Error Rate Testing

answer

CERT

question

Conversion Factor

answer

CF

question

Civilian Health and Medical Program of Veterans Affairs

answer

CHAMPUS

question

Clinical Laboratory Improvement Act

answer

CLIA

question

Competitive Medical Plan

answer

CMP

question

Centers of Medicare and Medicaid Services

answer

CMS

question

UB-04 Claim used by institutional and other selected providers to bill payers

answer

CMS-1450

question

Insurance claim used by noninstitutional providers and supplier to bill payers

answer

CMS-1500

question

clinical nurse specialist

answer

CNS

question

Coordination of Benefits

answer

COB

question

Consolidated Omnibus Budget Reconciliation Act of 1985

answer

COBRA

question

Ceterifed Professional Coder

answer

CPC

question

Current Procedural Terminology

answer

CPT

question

CHAMPUS Reform Initative

answer

CRI

question

Customized Sub-Capitation Plan

answer

CSCP

question

Computed Tomography

answer

CT

question

Debt Collection Assistance Officer

answer

DCAO

question

Defense Enrollment Eligibility Reporting System

answer

DEERS

question

Durable Medical Equipment

answer

DME

question

Durable Medical Equipment, Prosthetic and Orthotic Supplies

answer

DMEPOS

question

Durable Medical Equipment regional carriers

answer

DMERC

question

Department of Defense

answer

DOD

question

Diagnosis related groups

answer

DRG

question

Disproportionate share hospital (adjustment)

answer

DSH

question

Diagnostic and statistical manual

answer

DSM

question

(California) Employment Development Department

answer

EDD

question

Electronic data interchange

answer

EDI

question

Electronic funds transfer

answer

EFT

question

Employer group health plan

answer

EGHP

question

Electronic Healthcare Network Accreditation Commission

answer

EHNAC

question

Electronic Health Record

answer

EHR

question

Evaluation and Management

answer

E/M

question

Electronic Media Claim

answer

EMC

question

Electronic Medical Record

answer

EMR

question

Explanation of Benefits

answer

EOB

question

Exclusive provider organization

answer

EPO

question

Early and Periodic screening, diagnostic, and treatment

answer

EPSDT

question

External Quality Review Organization

answer

EQRO

question

Electronic Remittance Advice

answer

ERA

question

Employee Retirements income security Act of 1974

answer

ERISA

question

First Look Analysis for Hospital Outlier Monitoring

answer

FATHOM

question

False Claims Act

answer

FCA

question

Fair Debt Collection Practices Act

answer

FDCPA

question

Federal Employment Compensation Act

answer

FECA

question

Federal Employee Health Benefit Program

answer

FEHBP

question

Federal Employment Liability Act

answer

FELA

question

Federal Employee Program

answer

FEP

question

Federal Medical Assistance Percentage

answer

FMAP

question

Federal Proverty Level

answer

FPL

question

Federal Register

answer

FR

question

Flexible Spending Account

answer

FSA

question

General Equivalency Mapping

answer

GEM

question

General Enrollment Period

answer

GEP

question

Geographic Cost Practice Index

answer

GCPI

question

Group Practice Without Walls

answer

GPWW

question

Health Affairs

answer

HA

question

Home Assessment Validation and Entry

answer

HAVEN

question

Healthcare Finder

answer

HCF

question

Healthcare Common Procedure Coding System

answer

HCPCS

question

Healthcare reimbursement Account

answer

HCRA

question

Health Plan Employer Data and Information Set

answer

HEDIS

question

Home Health Resource Group

answer

HHRG

question

Healh Insurance claim number

answer

HICN

question

Health Insurance portability and accountability Act of 1996

answer

HIPAA

question

Health insurance prospective payment system (code set)

answer

HIPPS

question

Health Maintenance Organization

answer

HMO

question

Hospital Payment Monitoring Program

answer

HPMP

question

Health personnel shortage area

answer

HPSA

question

Health reimbursement arrangement

answer

HRA

question

Health Savings account

answer

HSA

question

Health savings security account

answer

HSSA

question

no,not

answer

a- an-

question

away from

answer

ab-

question

abdomen

answer

abdomin-

question

extremities, top

answer

acr-

question

toward

answer

ad-

question

toward

answer

-ad

question

fat

answer

adip-

question

pertaining to

answer

-al

question

vessel

answer

angi-

question

crooked, bent

answer

ankyl-

question

against

answer

anti-

question

joint

answer

arthr-

question

condition

answer

-asis

question

condition

answer

iasis

question

two

answer

bi-

question

eyelid

answer

blephar-

question

short

answer

brachy-

question

slow

answer

brady-

question

condition

answer

-esis

question

condition

answer

-isis

question

condition

answer

-sis

question

bronchial tube

answer

bronch-

question

heart

answer

cardi-

question

head

answer

cephal-

question

neck, cervix

answer

cervic-

question

vagina

answer

colp-, kolp-

question

against, opposite

answer

contra-

question

skull

answer

crani-

question

cold

answer

cry-

question

blue

answer

cyan-

question

tear

answer

dacry-

question

fingers, toes

answer

dactyl-

question

lack of, down

answer

de-

question

half

answer

demi-

question

skin

answer

derm-, dermat-

question

right

answer

dextr-

question

two

answer

di-

question

separation

answer

dis-

question

pain

answer

-dynia

question

bad, painful

answer

dys-

question

excision, removal

answer

-ectomy

question

vomiting

answer

-emesis

question

blood condition

answer

-emia

question

in, within

answer

en-

question

in, within

answer

end-, endo-

question

above, upon

answer

epi-

question

red

answer

erythr-

question

nervous sensation

answer

-esthesia

question

cause

answer

eti-

question

out, away from

answer

ex-

question

outside

answer

extra-

question

fiber

answer

fibr-

question

before

answer

fore-

question

milk

answer

galact-, lact-

question

stomach

answer

gaster-, gastr

question

genitals

answer

genit-

question

tongue

answer

gloss-

question

sugar, glucose

answer

gluc- glyc-

question

record

answer

-gram

question

instrument for reading

answer

-graph

question

process of recording

answer

-graphy

question

women, female

answer

gyn-, gyne-, gynec-

question

blood

answer

hem-

question

blood

answer

hema-

question

blood

answer

hemat-

question

half

answer

hemi-

question

liver

answer

hepat-

question

below, under

answer

hyp- hyph-

question

above, excessive

answer

hyper-

question

uterus, womb

answer

hyster-

question

condition

answer

-ia

question

condition

answer

-iasis

question

pertaining to

answer

-ic

question

ileum (small intestine)

answer

ileo-

question

ilium (hip bone)

answer

ilio-

question

in, into, not

answer

in-

question

within, into

answer

infra-

question

between

answer

inter-

question

within, into

answer

intra- intro-

question

same

answer

ipsi-

question

inflammation

answer

-itis

question

near

answer

juxta-

question

individual available at military treatment facility (MTF) to answer questions, help solve healthcare related problems, and assist beneficiaries in obtaining medical care through TRICARE; was previously called health benefits advisor (HBA)

answer

beneficiary counseling and assistance coordinator (BCAC)

question

begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.

answer

benefit period (Medicare)

question

not cancerous

answer

benign

question

the legal business name of the provider's pratice.

answer

billing entity

question

determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.

answer

birthday rule

question

nonpublished code edits, which were discontinued in 2000.

answer

black box edits

question

program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.

answer

BlueCard Program

question

insurance plan created in 1929 when Baylor University Hospital, in Dallas, TX, approached teachers in Dallas school district with a plan that guaranteed up to 21 days of hospitalization per year for subscribers and each dependent for a $6 annual premium.

answer

Blue Cross (BC)

question

joint venture between Blue Cross and Blue Shield where the corporation shared one building and computer

answer

Blue Cross Blue Shield (BCBS)

question

International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM)

answer

The coding system currently in use to report diagnoses and reasons for encounter is the:

question

Health Insurance Specialist

answer

The person who prepares and reviews claims for accuracy to ensure prompt payment is the :

question

Principles of right or good conduct

answer

Medical Ethics are:

question

Independent Contractor

answer

A person who performs services for another under an expressed or implied agreement is called a(n):

question

Preauthorization

answer

Which is an authorization that must be received from a payer before treatment by a specialist wil be covered?

question

Current Procedural Terminology (CPT)

answer

Which coding systerm is used to report professional services to payers?

question

Fluency in the language of medicine

answer

Which is a crucial skill that all health insurance specialists should learn in their training coursework?

question

Healthcare provider

answer

Which is a professional member of the healthcare team who provides servies or supplies to the insured?

question

Centers of Medicare and Medicaid Services-150 (CMS-1500)

answer

Which is the universal claim form used by physicians offices?

question

Explanation of Benefits

answer

Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?

question

Hold Harmless Clause

answer

Which term means the patient is not responsible for paying for what the insurance plan denies?

question

Health Insurance Claim

answer

Which document communicates to the payer that the provider is requesting reimbursement?

question

American Academy of Professional Coders (AAPC)

answer

Which professional association was founded to eleate the standards of medical coding by providing certification, ongoing education, networking, and recognition for coders?

question

American Health Information Managment Association (AHIMA)

answer

Which professioinal association was founded to improve the quality of medical records and current advances toward an electronic and global environment including the implementation of ICD-10-CM

question

...

answer

Which is a legal term that indicates that providers responsibility for their employees actions and omissions

question

joint venture between Blue Cross and Blue shield where the corporations shared one building and computer services but maintained seperate corporate identities.

answer

Blue Cross Blue Shield (BCBS)

question

an association of independent Blue Cross Blue Shield plans

answer

Blue Cross Blue Shield Association (BCBSA)

question

began as a resolution passed by the house of Delegates at an american Medical Association meetings in 1938; incorporates a concept of voluntary health insurance that encpurages physicians to corporate with prepaid health plans.

answer

Blue Shield (BS)

question

provides global medical coverage for active employees and their dependents who spend more than six months outside the United States for six months or more is eligible for Blue World Expat.

answer

Blue Worldwide Expat

question

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

answer

bonding insurance

question

unauthorized release of patient information to third party.

answer

breach of confidentiality

question

protect business assets and covers the cost of lawsuits resulting from bodily injury, and false advertising.

answer

business liability insurance

question

also called triple option plan; provides different health benefits palns and extra coverage options through an insure or third-party administrator

answer

cafeteria plan

question

provider accepts preestablished payments for providing healthcare services to enrollees over a period of time (usually one year).

answer

capitation

question

in stiu a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive (has not spread to deeper or adjacent tissues or organs).

answer

carcinoma (Ca) in stiu

question

cover the physician's time supervising a complex and multidisciplinary care treatment program for specific patient who is under the care of a home health agency, hospice, or nursing facility.

answer

care plan oversight services

question

also common law; based on a court decision that establishes a precedent.

answer

case law

question

development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.

answer

case management

question

process by which an attending physician coordinates and supervises care provided to patient by other providers.

answer

case mangement services process by which an attending physician coordinates and supervises care provided to patient by other providers.

question

submits written confirmation, authorizing treatment, to provider.

answer

case manager

question

the types and categories of patients treated by a healthcare provider.

answer

case mix

question

protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establisihing limits over which payments is not required

answer

catastropic cap benefit

question

the region defined by code boundaries within a 40-mile radius of a military treatment facility.

answer

catchment area

question

procedures/ services identified by a five- digit CPT code and descriptor nomnclature; these codes are traditionally associated with CPT and orginzed within six sections.

answer

Category I Codes

question

optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.

answer

Category II codes

question

temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.

answer

Category III codes

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