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| 11840138351 | Professional billing | charging for services performed by physicians, or non-physician practitioners. | 0 | |
| 11840143527 | Insurance billing specialist | An individual who processes health insurance claims in accordance with legal, professional, and insurance company guidelines and regulations. | 1 | |
| 11840145028 | Cash flow | Movement of the money you receive and the money you spend. | 2 | |
| 11840154910 | Medical ethics | moral conduct based on principles regulating the behavior of healthcare professionals | 3 | |
| 11840157745 | Clearinghouse | An independent organization that receives insurance claims from the physician's office, performs software edits, and redistributes the claims electronically to various insurance carriers. | 4 | |
| 11840177764 | Covered Entity | an entity that transmits health information in electronic form in connection with a transaction covered by HIPAA | 5 | |
| 11840186959 | Protected health information (PHI) | Any information about health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history. | 6 | |
| 11840195456 | Fraud | An intentional misrepresentation of the facts to deceive or mislead another. | 7 | |
| 11840204140 | Compliance | A process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry. | 8 | |
| 11840222868 | Embezzlement | A willful act by an employee of taking possession of an employer's money | 9 | |
| 11840232857 | Health insurance | A contract between the policy holder or member and insurance carrier or government program to reimburse the policy holder or member for all or portion of the cost of medical care rendered by health care professionals | 10 | |
| 11841605672 | Premium | The cost of insurance coverage paid annually, semiannually, or monthly to keep the policy in force. | 11 | |
| 11841612610 | Guarantor | An individual who promises to pay the medical bill by signing a form agreeing to pay or who accepts treatment constitutes an expressed promise. | 12 | |
| 11841617554 | Eligibility | Qualifying factors that must be met before a patient receives benefits under a specified insurance plan, government program, or managed care plan. | 13 | |
| 11841621691 | Deductible | A specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins covering health care costs. | 14 | |
| 11841626791 | Coinsurance | A cost-sharing requirement under a health insurance policy providing that the insured will assume a percentage of the costs for covered services. | 15 | |
| 11841634041 | Copayment | A patients payment of a portion of the cost at the time the service is rendered | 16 | |
| 11841639897 | Coordination of benefits (COB) | Two insurance carriers working together and coordinating the payment of their benefits so that there is no duplication of benefits paid between the primary and secondary insurance carriers. | 17 | |
| 11841645183 | Medical necessity | The performance of services and procedures that are consistent with the diagnosis in accordance with standards of good medical practice, performed at the proper level, and provided in the most appropriate setting. | 18 | |
| 11841650453 | Patient registration form | A questionnaire designed to collect demographic data and essential facts about medical insurance coverage for each patient seen for professional services | 19 | |
| 11841655717 | Participating provider (PAR) | A physician who contracts with a health maintenance organization (HMO) or other insurance company to provide services | 20 | |
| 11841664601 | Encounter form | An all-encompassing billing form personalized to the practice of the physician, it may be used when a patient submits an insurance billing; also called charge slip, communicator, multipurpose billing form, fee ticket, patient service slip, routing form, superbill, and transaction slip. | 21 | |
| 11841669310 | Primary care physician (PCP) | A physician who oversees the care of patients in a managed health care plan (HMO or PPO) and refers patients to see specialists for services as needed | 22 | |
| 11841677870 | New Patient (NP) | An individual who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years | 23 | |
| 11841682350 | Established patient (EP) | An individual who has received professional services with in the past 3 years from the physician or another physician of the same specialty who belongs to the same group practice | 24 | |
| 11841689817 | Referral | The transfer of the total or specific care of a patient from one physician to another. In managed care, a request for authorization for a specific service | 25 | |
| 11841695027 | Chief complaint | Patient's statement describing symptoms, problems, or conditions as the reason for seeking health care services from a physician. | 26 | |
| 11841699897 | Primary diagnosis | initial identification of the condition or chief complaint for which the patient is treated for outpatient medical care | 27 | |
| 11841709164 | HIPAA | Health Insurance Portability and Accountability Act of 1996 | 28 | |
| 11841718757 | ICD-10-CM | International Classification of Diseases, 10th Revision, Clinical Modification | 29 | |
| 11841721355 | Diagnostic codes | Numeric or alphanumeric characters used to classify and report diseases, conditions, and injuries. | 30 | |
| 11841726521 | Combination code | Single code used to classify two diagnoses | 31 | |
| 11841727707 | CPT | Current Procedural Terminology | 32 | |
| 11841728550 | Procedural coding | codes for reporting each procedure and service the physician performed in treating the patient | 33 | |
| 11841746550 | Modifers | Added information or changed description of procedures and services, and are a part of valid CPT or HCPCS codes. | 34 | |
| 11841751873 | Fee schedule | A list of charges or established allowances for specific medical services and procedures | 35 | |
| 11841757655 | Surgical package | combination of services included in a single procedure code | 36 | |
| 11841759775 | Unbundling | Separating out the individual goods, services, or ideas that make up a product and pricing each one individually. | 37 | |
| 11841770573 | Comprehensive code | A single procedural code that describes or covers two or more CPT component codes that are bundled together as one unit | 38 | |
| 11841774950 | Bilateral | both sides | 39 | |
| 11841776470 | upcoding | Deliberate manipulation of CPT codes for increased payment | 40 | |
| 11841779508 | CMS-1500 form | the standard form used by health-care providers to bill for services, including disease state management services. | 41 | |
| 11841787552 | Paper claim | A hard copy of an insurance claim, which is completed and sent by surface mail. | 42 | |
| 11841789521 | Electronic claim | a health care claim that is transmitted electronically; also known as an electronic media claim (EMC) | 43 | |
| 11841791077 | Clean claim | health insurance claim form that has been completed correctly without any errors or omissions | 44 | |
| 11841793425 | Pending claim | An insurance claim held in suspense because of review or other reason. These claims may be cleared for payment or denied | 45 | |
| 11841796015 | Rejected claim | requires investigation and needs further clarification | 46 | |
| 11841798241 | Date of service (DOS) | The date the service is provided. | 47 | |
| 11841798879 | NPI | National Provider Identifier | 48 | |
| 11841799761 | Electronic data interchange | the computer-to-computer exchange of business documents from a retailer to a vendor and back | 49 | |
| 11841802985 | Electronic funds transfer (EFT) | A system that transfers cash by electronic communication rather than by paper documents. | 50 | |
| 11841805329 | Electronic remittance advice (ERA) | an electronic document that lists patients, dates of service, charges, and the amount paid or denied by the insurance carrier | 51 | |
| 11841807520 | Explanation of Benefits (EOB) | paper document from a payer that shows how the amount of a benefit was determined | 52 | |
| 11841811436 | _____________________is done for services rendered by the provider and does not include charges for the facility. | Professional billing | 53 | |
| 11841812092 | Adjustment | small change | 54 | |
| 11841813024 | Charges | amounts a provider bills for the services performed | 55 | |
| 11841814890 | Appeal | a request for a review of an insurance claim that has been underpaid or denied by an insurance company in an effort to receive additional payment | 56 | |
| 11841821095 | Overpayment | Money paid over and above the amount due by the insurer or patient. | 57 | |
| 11852866324 | Advance Beneficiary Notice of Noncoverage (ABN) | An agreement given to the patient to read and sign before rendering a service if the participating physician thinks it may be denied for payment because of medical necessity or limitation of liability by Medicare. The patient agrees to pay for the service; also know as a waiver of liability agreement or responsibility statement. | 58 | |
| 11852883944 | Accounts receivable | The total amount of money owed for professional services rendered | 59 | |
| 11852900152 | Financial accounting record | An individual record indicating charges, payments, adjustments, and balances owed for services rendered, also known as a ledger | 60 | |
| 11852937494 | Medicare, Medicaid, Blue Cross, TRICARE and Labor and Industries are all examples of | Third-party payers | 61 | |
| 11852982638 | is amount of actual money generated and available for use by the medical practice | cash flow | 62 | |
| 11852990443 | Intentional misrepresentation of the facts to deceive another is known as | fraud | 63 | |
| 11853030327 | A_______________receives insurance claims from the provider's office, performs edits and transmits claims to insurance carriers | clearinghouse | 64 | |
| 11853036367 | The first step for a managed care referral is | make an appointment | 65 | |
| 11853201467 | An individual promising to pay for medical services rendered is known as/an | Guarantor | 66 | |
| 11853218839 | A monthly, quarterly or annual amount of money a patient must pay to keep their insurance coverage active is known as a/an | premium | 67 | |
| 11853259271 | The process for locating a code in the ICD-10-CM Book is to look in the __________, then locate the code in the ________________ | Alpha index; Tabular list | 68 | |
| 11853297438 | Two billing components are facility billing and professional billing. ______________billing is done by providers. | Professional | 69 | |
| 11853384018 | Under HIPAA guidelines, medical providers that transmit data electronically are considered | covered entity | 70 | |
| 11853399641 | A _____________code is used when two diagnoses are classified with a single code | combination code | 71 | |
| 11853408676 | is a healthcare employee's top priority | patient | 72 | |
| 11853589408 | Standards of conduct that are generally accepted as moral guides for behavior are known as | Medical ethics | 73 | |
| 11853611811 | ________________is the process of meeting regulations, recommendations and expectations of federal and state agencies that pay for health care services | Compliance | 74 | |
| 11853658685 | Information that identifies an individual and describes their health status is known as | Protected Health Information (PHI) | 75 | |
| 11853693949 | Stealing money that has been entrusted to one's care is known as | embezzlement | 76 | |
| 11853711587 | _______is a contract between a policy holder and third-party payer to reimburse the policyholder for the cost of medical care | Health Insurance | 77 | |
| 11853731027 | Questionnaire designed to collect demographic data and essential facts about medical insurance coverage | Patient Registration Form | 78 | |
| 11853791490 | Coordination between multiple payers to establish which payer is primary, secondary and so o is known as | Coordination of Benefits (COB) | 79 | |
| 11853959188 | A patient that has NOT received any professional services from the physician within the past three years is considered a/an ________________. A patient who has received professional services from the physician within the past three years is considered a/an _________________. | New patient (NP); Etablished patient (EP) | 80 | |
| 11854120927 | Medical practices use ________________ on insurance claims to explain the reason the patient has sought health care services | diagnosis codes | 81 | |
| 11854550314 | When submitting insurance claims for patients seen in the physician's office, the ______________(first listed condition) is the main reason for the encounter. | Chief complaint | 82 | |
| 11854566511 | ____________is defined as the performance of services that are needed by the patient for the diagnosis or treatment of a medical condition | Medical necessity | 83 | |
| 11854699994 | _______________is the standard paper claim form used by healthcare professionals | CMS-1500 (02-12) claim form | 84 | |
| 11854738206 | The ________________ is a lifetime 10-digit number assigned to each provider | (NPI) National Provider Identifier | 85 | |
| 11854790160 | An ________________ will show the outstanding claims and categorize them as current, 30 days, 60 days, 90 days and 120 days | Aging report | 86 | |
| 11854800723 | ____________codes are used to report medical conditions, signs or symptoms. _______________codes used to report medical services or procedures provided | ICD-10-CM; CPT | 87 | |
| 11854847680 | A ________________ is mailed or faxed to third party payers in oerder for providers to get reimbursed for services provided. An __________ medical claim is submitted to third party payers using electronic data interchange. | paper claim; electronic claim | 88 | |
| 11854895745 | A __________claim is a claim submitted timely that includes all necessary information to that it can be paid promptly | clean claim | 89 | |
| 11854911956 | Payment from a third-party payer that goes directly into the provider's bank account is done by | Electronic funds transfer | 90 | |
| 11854967754 | Electronic notice of payments and adjustments sent to the provider's office is an | R/A | 91 | |
| 11854992126 | ________________________is a document issued to the patient and provider that explains the allowable amount payable, write off amount and amount patient is responsible for | Explanation of Benefits (EOB) | 92 | |
| 11855056300 | Medicare notice to patient of a noncovered item is the | Advance Beneficiary Notice of Noncoverage (ABN) | 93 | |
| 11855077361 | Request for payment by asking for a review of a claim that has been underpaid, incorrectly paid or denied by an insurance company | appeal | 94 | |
| 11855104201 | _________is the unpaid balances that are due from patients and third-party payers for services that have been rendered | accounts receivable | 95 | |
| 11855116759 | ________________________is the individual record indicating charges, payments adjustments, and balances owed for services rendered | financial accounting record? | 96 |
