Coding Chapter 1

Front 1

AAMT

Back 1

AAMT: American association for medical transcription

Front 2

AAPC

Back 2

AAPC: American academy of professional coders

Front 3

Abuse

Back 3

Abuse: incidents that are inconsistent with good business practices and result in improper reimbursement.

Front 4

ACAP

Back 4

ACAP: alliance of claims assistance professionals

Front 5

Admitting Clerk

Back 5

Admitting Clerk: front desk representative who registers and greets patients.

Front 6

AHIMA

Back 6

AHIMA: American Health Information Management Association

Front 7

Bundling

Back 7

Bundling: individual procedures that are considered part of a larger operation and are grouped together or “bundled”.

Front 8

Capitation

Back 8

Capitation: a predetermined amount of reimbursement based “per capita” or per person.

Front 9

CCA

Back 9

CCA: certified coding associate

Front 10

CCI Edits (also known as NCCI, or National Correct Coding Initiative):

Back 10

CCI Edits (also known as NCCI, or National Correct Coding Initiative): series of CPT codes sets in which one code is excluded from use because of its direct correlation to the other

Front 11

CCPC

Back 11

CCPC: Certified Professional Coder

Front 12

CCS

Back 12

CCS: certified coding specialist

Front 13

CCS-P

Back 13

CCS-P certified coding specialist- physician

Front 14

Centralized Billing Office (CBO):

Back 14

Centralized Billing Office (CBO): an outside contract that handles the physician’s claims and accounts receivables.

Front 15

Certifications

Back 15

Certifications: training received in a particular field that acknowledges a medical office specialist expertise.

Front 16

Clean Claim

Back 16

Clean Claim: a complete, correct health insurance claim that passes through age, sex, diagnosis to procedure and other edits set up by third party payers. (Medicare and Medicaid)

Front 17

Clustering

Back 17

Clustering: assigning codes to one or two middle levels of service codes exclusively, under the philosophy that some will be higher, some lower, and they will average out over an extended period. ( in reality, it over charges some while under charging others)

Front 18

CMAA

Back 18

CMAA: certified medical administrative assistant

Front 19

CMBS

Back 19

CMBS: certified medical billing specialist

Front 20

CMS

Back 20

CMS: a federal agency, the center for Medicare and Medicaid, formerly known as HCFA (Health Care Financing Administration).

Front 21

Compliance Plan

Back 21

Compliance Plan: a written statement by a healthcare entity, describing the ethical actions of that business. (must contain all the steps required from the government)

Front 22

CPC

Back 22

CPC: certified professional coder

Front 23

CPC-A

Back 23

CPC-A: certified professional coder -apprentice

Front 24

CPC-H

Back 24

CPC-H: certified professional coder- hospital

Front 25

CPC-H-A

Back 25

CPC-H-A: certified professional coder- hospital- apprentice

Front 26

Denial

Back 26

Denial: claim that is rejected by insurance companies, medicare, or medicaid after failing editing system.

Front 27

False Claim Act

Back 27

False Claim Act: prohibits knowingly presenting a false or fraudulent claim to the federal government for payment or presenting false records or statements in order to get a claim paid.

Front 28

Fee For Service

Back 28

Fee For Service: basic reimbursement method based on individual physicians charges.

Front 29

Fraud

Back 29

Fraud: to purposely bill for services that were never given or to bill for a service that has a higher reimbursement than the service provided.

Front 30

HCPCS

Back 30

HCPCS: health care procedure coding system

Front 31

HIMSS

Back 31

HIMSS: healthcare information and management systems society

Front 32

HIPPA

Back 32

HIPPA: health insurance portability and accountability act

Front 33

HPI

Back 33

HPI: Health professional institute

Front 34

Insurance Verification Representative

Back 34

Insurance Verification Representative: a representative that coordinates all financial aspects of the patients visit. This includes admissions, insurance verification, precertification, follow ups of payments and denials.

Front 35

LCD ( Local Coverage Determination)

Back 35

LCD ( Local Coverage Determination):determines medicare coverage for individual medicare carriers in the absence of a national policy.

Front 36

MAB

Back 36

MAB: medical association of billers

Front 37

Medical Biller

Back 37

Medical Biller: submits and tracks all insurance claims and insures that insurance companies correctly reimburse the health care provider.

Front 38

Medical Coder

Back 38

Medical Coder: assigns numerical codes to diagnoses and procedures using ICD 9 CM and CPT manuals.

Front 39

Medical Necessity

Back 39

Medical Necessity: the reason why a service was provided, translated into an ICD 9 diagnosis code.

Front 40

medical office assitant

Back 40

front office staff that primarily handles administraitive duties to make the office run smoothly. ( scheduling, confirming appointments, filing, answering phones)

Front 41

medical poster

Back 41

contacts patients and insurnce carriers to collect money owed to the medical facility

Front 42

MGMA

Back 42

MGMA: medical group management association

Front 43

NCCT

Back 43

NCCT: National Center for Competency Testing

Front 44

NCICS

Back 44

NCICS: national certified insurance coding specialist

Front 45

NCMOA

Back 45

NCMOA: national certified medical office assistant

Front 46

NHA

Back 46

NHA: National Healthcareer Association

Front 47

OIG

Back 47

OIG: Office Of Inspector General

Front 48

OSHA

Back 48

OSHA: occupational safety and health administration

Front 49

PAHCOM

Back 49

PAHCOM: professional association of health care office managers

Front 50

Patient Account Services (PAS)

Back 50

Patient Account Services (PAS): a facility that centralizes the billing of patients and carriers for treatment (TX) received at an inpatient facility.

Front 51

patient information clerk

Back 51

responsible for answering questions about and explaining HIPAA, privacy regulations, living wills, do not resusitate ordersand other information to patients and their family members.

Front 52

payment poster

Back 52

reads the explaination of benefits issued by isurance carriers and posts payments or adjustments to the appropriate patient account

Front 53

PPS (Perspective Payment System)

Back 53

PPS (Perspective Payment System): a reimbursement method designed to pay a fixed amount per hospitalization. It is based on the diagnosis, historical case-mix information, and geographical location.

Front 54

Primary Diagnosis

Back 54

Primary Diagnosis: the principal diagnosis, or reason why a person seeks healthcare.

Front 55

Qui Tam

Back 55

Qui Tam: a “whistle blower” or “relator”, in reference to Qui Tam lawsuits.

Front 56

refund specialist

Back 56

analyzes patient accounts to disern whether or not a refund is required and to whom the refund should be returned

Front 57

Registered Health Information Technician (RHIT)

Back 57

Registered Health Information Technician (RHIT): coordinates services related to inpatient coding, medical documentation, abstracting, debt collection, and reimbursement requirements, supervises inpatient medical coding.

Front 58

Third Party Payer

Back 58

Third Party Payer: a nongovernmental insurance company. Also known as “private payer” or commercial insurance.

Front 59

Unbundling

Back 59

Unbundling: the practice of billing for multiple components of a service that must be included in a single fee.

Front 60

Upcoding

Back 60

Upcoding: billing for a more expensive service than the one that was actually performed.