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39 Cards in this Set
- Front
- Back
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AAPC |
American Academy of Professional Coders 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 networks, and to increase and promote national recognition and awareness of professional coding |
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AAMA |
American association of Medical Assistants enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalis required by employers and patients; as well as protect medical assistants' right to practice |
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AHIMA |
American health information management association founded in 1928 improves quality of medical records implementation of ICD-10 and ICD-10 PCS in 2013 |
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AMBA |
American Medical Belling Association offers the Certified Medical Reimbursement Specialist program which recognizes competency of members who have met high standards of proficiency |
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bonding insurance |
an insurance agreement that guarantees repayment for financial losses resulting from the act or failure to act of an employee protects the financial operations of the employee |
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business liability insurance |
protects business assets and covers the cost of lawsuits resulting from bodily injury personal injury and false advertising |
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CMS |
centers for medicare and medicaid services formerly know a the health care finanincing Administration an administrative agency within the federal department of health and human services |
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claims examiners |
employed by third-party payers to review health-related claims to determine whether the charges are reasonable and medically necessary based on the patient's diagnosis |
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coding |
process of reporting diagnoses procedures and services as numeric and alphanumeric characters on the insurance claim |
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CPT |
current procedural terminology published by the American Medical Association includes five digit numeric codes and descriptors for procedures and services performed by providers |
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embezzle |
the illegal transfer of money or property as a fraudulent action |
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errors and omissions insurance |
provides protection from claims resulting from errors and omissions associated with professional services provided to clients as expected ofa person in their profession; also called errors and omissions insurance |
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ethics |
principle of right or good conduct; rules that govern the conduct of members of a profession |
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EOB |
explanation of benefits report that details the results of processing a claim |
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HCPCS level II codes |
national codes published by the CMS which include 5 digit alphanumeric codes for procedures services and supplies not classified in CPT |
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health care provider |
physician or other health care practitioner |
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health information technician |
professional who manage patient health information and medical records administer computer information systems, and code diagnoses and procedures for health care services provided |
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health insurance claim |
documentation submitted to an insurance plan requesting reimbursement for health care services provided |
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health insurance specialist |
person who reviews health-related claims to determine the medical necessity for procedures or services erformed before payment is made to the provider |
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HCPCS |
healthcare common procedure coding system coding system that consists of CPT national codes and local codes |
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hold harmless cause |
policy that the patient is not responsible for paying what the insurance plan denies |
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independent contractor |
defined as a person who performs services for another under and express or implied agreement and who is not subject to the other's control or right to control of the manner and means of performing the services the organization that hires and independent contractor is not liable for the acts or omissions of the independent contractor |
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ICD-10-CM |
international classiciation of diseases 10th revision coding system to be implemented October 1, 2013 used to report diseases, injuries, and other reasons for inpatient and outpatient encounters |
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ICD-10-PCS |
coding system to be implemented on October 1, 2013 and used to report procedures and services on impatient claims |
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internship |
nonpaid professional practice experience that benefits students and facilities that accept students for placement; students receive on-the-job experience prior to graduation, and the internship assists them in obtaining permanent employment |
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medical assistant |
employed by a provider to perform administrative and clinical tasks that keep the office/clinic running smoothly |
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(MAB) |
Medical Association of Billers created in 1995 to provide medical billing and coding specialists with a reliable source for diagnosis and procedure coding education and training |
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medical malpractice insurance |
a type of liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatent |
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medical necessity |
involves linking every procedure or service code reported on an insurance claim to a condition code that justifies the need to perform the procedure/service |
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national codes |
commonly referred to as HCPCS level II codes include 5 digit alphanumeric codes for procedures services and supplies that are not classified in CPT |
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preauthorization |
prior approval |
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professional liability insurance |
provides protection from claims resulting from errors and omissions associated with professional services provided to clients as expected of a person in their profession also called errors and omissions insurance |
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professionalism |
conduct or qualities that characterize a professional person |
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property insurance |
protects businesses contents (buildings and equipment) from fire, theft, and other risks |
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reimbursement specialist |
person who reviews health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider |
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remittance advice |
electronic or paper based report of payment sent by the payer to the provider includes patient name health insurance claim number and other remark codes |
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respondeat |
legal doctrine holding that the employer is liable for the actions and omissions of employees performed and comitted within the scope of their employment |
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scope of practice |
health care services, determined by the state, that an NP and PA can perform |
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workers' compensation insurance |
insurance program, mandated by deferal and state governments that requires employers to cover medical expenses and loss of wages for workers who are injured on the job or who have developed job-related disorders |
