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20 Cards in this Set
- Front
- Back
professional association that represents professionals dedicated to the effective management of health insurance claims; its membership includes professional electronic billers who work for providers as well as well as professional claims assistance professionals who work for patients.
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Alliance of Claims Assistance
Professionals (ACAP) |
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offers 4 certification exams for coders
1.Certified Professional Coder Apprentice (CPC-A) 2.Certified Professional Coder-Hospital Apprentice(CPC-HA) 3.Certified Professional Coder (CPC) 4.Certified Professional Coder-Hospital (CPC-H) |
American Academy of Professional Coders
(AAPC) |
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1. Certified Professional Coder-
Apprentice (CPC-A) 2. Certified Professional Coder- Hospital Apprentice (CPC-HA) 3. Certified Professional Coder (CPC) 4. Certified Professional Coder (CPC-H) |
American Academy of Professional Coders
(AAPC):established to provide national certification and credential-ing process, and to support nat'l and local membership by providing educ. prods. and opportunities to network, and to increase and promote nat'l recognition & awareness of professional coding. |
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Professional association that represents more than 40,000 health information management professionals who work throughout the health care industry.
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American Health Information Management
Association (AHIMA) |
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An administrative agency within the Federal Dept. of Health and Human Services.
(formally known as HCFA-Health Care Financing Services) |
Centers for Medicare and Medicaid Svcs.
(CMS) |
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The process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the insurance claim.
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CODING
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Published by the American Medical Association and includes five-digit numeric codes and descriptors for procedures and servoes performed by providers (e.g., 99203 identifies a detailed office visit for a new patient)
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Current Procedural Terminology (CPT)
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Sending data in a standardized machine-readable format to an insurance company via disk, telephone, or cable.
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electronic claims processing
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The mutual exchange of data between provider and payer.
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electronic data interchange (EDI)
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The priciple of right or good conduct; rules that govern the conduct of members of a profession.
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ETHICS
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A report that details the results of processing a claim (e.g., payer reimburses prover $80.00 on a submitted charge of $100.00)
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explanation of benefits (EOB)
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A physician or other health care practioner (ex: physician's assistant)
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health care provider
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The coding system that that consists of CPT, national codes (level II), and local codes (level III),;local codes were discontinued in 2003; previously known as HCFA Common Procedure Coding System.
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Healthcare Common Procedure Coding Sys.
(HCPCS) |
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Documentation submitted to an insurance plan requesting reimbursement for health care services provided (ex.: CMS-1500 and UB-92)
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health insurance claim
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The patient is not responsible for what the insurance plan denies.
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hold harmless clause
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The coding system used to report diagnoses and reasons for encounters on physician office claims
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International Classification of Diseases
9th Revision-Clinical Modifications (ICD-9-CM) |
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developed by local insurance companies and include five-digit alphanumeric codes for procedures, services, and supplies that are also not classified in CPT
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local codes
(level III codes) |
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involves linking every procedure or service reported to the insurance company to a condition that justifies the necessity for performing that procedure or service.
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medical necessity
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commonly referred to as HCPCS codes, which include five-digit alphanumeric codes for procedures, services, and supplies that are not classified in CPT
ex: J codes are used to assign drugs administered |
National Codes (level II codes)
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prior approval
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Prior Authorization
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