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60 Cards in this Set
- Front
- Back
AAMT |
AAMT: American association for medical transcription
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AAPC
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AAPC: American academy of professional coders
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Abuse
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Abuse: incidents that are inconsistent with good business practices and result in improper reimbursement.
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ACAP
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ACAP: alliance of claims assistance professionals
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Admitting Clerk
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Admitting Clerk: front desk representative who registers and greets patients.
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AHIMA
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AHIMA: American Health Information Management Association
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Bundling
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Bundling: individual procedures that are considered part of a larger operation and are grouped together or “bundled”.
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Capitation
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Capitation: a predetermined amount of reimbursement based “per capita” or per person.
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CCA
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CCA: certified coding associate
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CCI Edits (also known as NCCI, or National Correct Coding Initiative):
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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
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CCPC
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CCPC: Certified Professional Coder
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CCS
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CCS: certified coding specialist
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CCS-P
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CCS-P certified coding specialist- physician
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Centralized Billing Office (CBO):
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Centralized Billing Office (CBO): an outside contract that handles the physician’s claims and accounts receivables.
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Certifications |
Certifications: training received in a particular field that acknowledges a medical office specialist expertise.
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Clean Claim
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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)
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Clustering
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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)
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CMAA
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CMAA: certified medical administrative assistant
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CMBS
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CMBS: certified medical billing specialist
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CMS
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CMS: a federal agency, the center for Medicare and Medicaid, formerly known as HCFA (Health Care Financing Administration).
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Compliance Plan
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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)
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CPC
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CPC: certified professional coder
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CPC-A
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CPC-A: certified professional coder -apprentice
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CPC-H
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CPC-H: certified professional coder- hospital
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CPC-H-A |
CPC-H-A: certified professional coder- hospital- apprentice
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Denial
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Denial: claim that is rejected by insurance companies, medicare, or medicaid after failing editing system.
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False Claim Act
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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.
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Fee For Service
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Fee For Service: basic reimbursement method based on individual physicians charges.
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Fraud
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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.
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HCPCS
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HCPCS: health care procedure coding system
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HIMSS
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HIMSS: healthcare information and management systems society
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HIPPA
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HIPPA: health insurance portability and accountability act
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HPI
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HPI: Health professional institute
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Insurance Verification Representative
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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.
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LCD ( Local Coverage Determination)
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LCD ( Local Coverage Determination):determines medicare coverage for individual medicare carriers in the absence of a national policy.
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MAB
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MAB: medical association of billers
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Medical Biller
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Medical Biller: submits and tracks all insurance claims and insures that insurance companies correctly reimburse the health care provider.
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Medical Coder
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Medical Coder: assigns numerical codes to diagnoses and procedures using ICD 9 CM and CPT manuals.
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Medical Necessity
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Medical Necessity: the reason why a service was provided, translated into an ICD 9 diagnosis code.
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medical office assitant
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front office staff that primarily handles administraitive duties to make the office run smoothly. ( scheduling, confirming appointments, filing, answering phones)
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medical poster
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contacts patients and insurnce carriers to collect money owed to the medical facility
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MGMA
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MGMA: medical group management association
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NCCT
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NCCT: National Center for Competency Testing
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NCICS
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NCICS: national certified insurance coding specialist
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NCMOA
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NCMOA: national certified medical office assistant
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NHA
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NHA: National Healthcareer Association
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OIG
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OIG: Office Of Inspector General
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OSHA
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OSHA: occupational safety and health administration
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PAHCOM |
PAHCOM: professional association of health care office managers
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Patient Account Services (PAS) |
Patient Account Services (PAS): a facility that centralizes the billing of patients and carriers for treatment (TX) received at an inpatient facility.
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patient information clerk
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responsible for answering questions about and explaining HIPAA, privacy regulations, living wills, do not resusitate ordersand other information to patients and their family members.
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payment poster
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reads the explaination of benefits issued by isurance carriers and posts payments or adjustments to the appropriate patient account
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PPS (Perspective Payment System)
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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.
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Primary Diagnosis |
Primary Diagnosis: the principal diagnosis, or reason why a person seeks healthcare.
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Qui Tam
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Qui Tam: a “whistle blower” or “relator”, in reference to Qui Tam lawsuits.
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refund specialist
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analyzes patient accounts to disern whether or not a refund is required and to whom the refund should be returned
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Registered Health Information Technician (RHIT)
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Registered Health Information Technician (RHIT): coordinates services related to inpatient coding, medical documentation, abstracting, debt collection, and reimbursement requirements, supervises inpatient medical coding.
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Third Party Payer
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Third Party Payer: a nongovernmental insurance company. Also known as “private payer” or commercial insurance.
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Unbundling
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Unbundling: the practice of billing for multiple components of a service that must be included in a single fee.
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Upcoding
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Upcoding: billing for a more expensive service than the one that was actually performed. |