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Medical Billing and Coding Terminology Flashcards

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14921721915ABNADVANCED BENEFICIARY NOTICE0
14921721916AMAAMERICAN MEDICAL ASSOCIATION1
14921721917AOBASSIGNMENTS OF BENEFITS2
14921721918CDCCENTER FOR DISEASE CONTROL3
14921721919CPT-4CURRENT PROCEDURAL TEMINOLOGY 4TH VERSION4
14921721920DNRDO NOT RESUSCITATE5
14921721921EHRELECTRONIC HEALTH RECORD6
14921721922EMRELECTRONIC MEDICAL RECORD7
14921721923EOBEXPLANATION OF BENEFITS8
14921721924HCPCSHEALTHCARE COMMON PROCEDURE CODING SYSTEM9
14921721925HHSHEALTH AND HUMAN SERVICES10
14921721926HIPAAHEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT11
14921721927HMOHEALTH MAINTENANCE ORGANIZATION12
14921721928ICD-10 CMINTERNATIONAL CLASSIFICATION OF DISEASE 10 REVISION CLINICAL MODICATION13
14921721929IIHIINDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION14
14921721930NPPNOTICE OF PRIVACY PRACTICES15
14921721931OCROFFICE OF CIVIL RIGHTS16
14921721932OIGOFFICE OF INSPECTOR GENERAL17
14921721933P&PPOLICIES AND PROCEDURES18
14921721934PHIPROTECTED HEALTH INFORMATION19
14921721935POPRIVACY OFFICER20
14921721936POMRPROBLEM-ORIENTED MEDICAL RECORD21
14921721937PPOPREFERRED PROVIDER ORGANIZATION22
14921721938RAREMITTANCE ADVICE23
14921721939RBRVSRESOURCE BASED RELATIVE VALUE SCALE24
14921721940SOSECURITY OFFICER25
14921721941SOAPSUBJECTIVE, OBJECTIVE, ASSESSMENT PLAN26
14921721942TPOTREATMENT PAYMENT AND HEALTHCARE OPERATIONS27
14921721943ABSTRACTINGTHE EXTRACTION OF SPECIFIC DATA FROM A MEDICAL RECORD, OFTEN FOR USE IN AN EXTERNAL DATABASE, SUCH AS A CANCER REGISTRY.28
14921721944ABUSEPRACTICES THAT DIRECTLY OR INDIRECTLY RESULT IN UNNECESSARY COSTS TO THE MEDICARE PROGRAM.29
14921721945ACCOUNT NUMBERNUMBER THAT IDENTIFIES SPECIFIC EPISODE OF CARE, DATE OF SERVICE OR PATIENT.30
14921721946ACCOUNTS RECEIVABLE DEPARTMENTDEPARTMENT THAT KEEPS TRACK OF WHAT THIRD-PARTY PAYERS THE PROVIDER IS WAITING TO HEAR FROM AND WHAT PATIENTS ARE DUE TO MAKE PAYMENTS.31
14921721947ADVANCED BENEFICIARY NOTICE OF NON-COVERAGEFORM PROVIDED IF A PROVIDER BELIEVES THAT A SERVICE MAY BE DECLINED BECAUSE MEDICARE MIGHT CONSIDER UNNECESSARY.32
14921721948AGING REPORTMEASURES THE OUTSTANDING BALANCES IN EACH ACCOUNT33
14921721949AHIMAAMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION.34
14921721950ALLOWABLE CHARGETHE AMOUNT AN INSURER WILL ACCEPT AS FULL PAYMENT MINUS APPLICABLE COST SHARING35
14921721951APC GROUPERHELPS CODERS DETERMINE THE APPROPRIATE AMBULATORY PAYMENT CLASSIFICATIN (APC) FOR AN OUTPATIENT ENCOUNTER36
14921721952AUDITINGREVIEW OF CLAIMS FOR ACCURACY AND COMPLETENESS37
14921721953AUTHORIZATIONPERMISSION GRANTED BY THE PATIENT OR THE PATIENT'S REPRESENTATIVE TO RELEASE INFORMATION FOR REASONS OTHER THAN TPO.38
14921721954BALANCE BILLINGBILLING PATIENTS FOR CHARGES IN EXCESS OF THE MEDICARE FEE SCHEDULE39
14921721955BATCHA GROUP OF SUBMITTED CLAIMS40
14921721956BUSINESS ASSOCIATE (BA)INDIVIDUALS, GROUPS OR ORGANIZATIONS WHO ARE NOT MEMBERS OF A COVERED ENTITY'S WORKFORCE THAT PERFORM FUNCTIONS OR ACTIVITIES ON BEHALF OF OR FOR A COVERED ENTITY.41
14921721957CARC'SCLAIM ADJUSTMENT REASON CODES42
14921721958CLEAN CLAIMCLAIM THAT IS ACCURATE AND COMPLETE. ALL INFORMATION IS FILLED OUT AND CLAIM IS FILED IN A TIMELY MANNER.43
14921721959CLEARINGHOUSEAGENCY THAT CONVERTS CLAIMS INTO A STANDARDIZED ELECTRONIC FORMAT, LOOKS FOR ERRORS AND FORMATS THEM ACCORDING TO HIPAA AND INSURANCE STANDARDS44
14921721960CMSCENTERS FOR MEDICARE AND MEDICAID SERVICES45
14921721961COINSURANCETHE PRE-ESTABLISHED PERCENTAGE OF EXPENSES PAID BY THE INSURANCE COMPANY AFTER THE DEDUCTIBLE HAS BEEN MET.46
14921721962COMPUTER-ASSISTED CODING (CAC)SOFTWARE THAT SCANS THE ENTIRE PATIENT'S ELECTRONIC RECORD AND CODES THE ENCOUNTER BASED ON THE DOCUMENTATION IN THE RECORD.47
14921721963CONDITIONAL PAYMENTMEDICARE PAYMENT THAT IS RECOVERED AFTER PRIMARY INSURANCE PAYS.48
14921721964CONSENTA PATIENT'S PERMISSION EVIDENCED BY SIGNATURE49
14921721965COORDINATION OF BENEFITSDETERMINES WHICH INSURANCE PLAN IS PRIMARY AND WHICH IS SECONDARY50
14921721966COPAYMENTA FIXED DOLLAR AMOUNT THAT MUST BE PAID EACH TIME A PATIENT VISITS A PROVIDER51
14921721967COST SHARINGTHE BALANCE THE POLICYHOLDER MUST PAY TO THE PROVIDER52
14921721968CROSS OVER CLAIMCLAIM SUBMITTED BY PEOPLE COVERED BY A PRIMARY AND SECONDARY PLAN53
14921721969DEDUCTIBLETHE AMOUNT OF MONEY A PATIENT MUST PAY OUT OF POCKET BEFORE THE INSURANCE COMPANY WILL START TO PAY FOR COVERED BENEFITS54
14921721970DE-IDENTIFIED INFORMATIONINFORMATION THAT DOES NOT IDENTIFY AN INDIVIDUAL BECAUSE UNIQUE AND PERSONAL CHARACTERISTICS HAVE BEEN REMOVED55
14921721971DEMOGRAPHIC INFORMATIONDATE OF BIRTH, SEX, MARITAL STATUS, ADDRESS, PHONE NUMBER, RELATIONSHIP TO SUBSCRIBER, AND CIRCUMSTANCES OF CONDITIONS.56
14921721972DIRTY CLAIMCLAIM THAT IS INACCURATE, INCOMPLETE, OR CONTAINS OTHER ERRORS.57
14921721973ELECTRONIC DATA EXCHANGE (EDI)THE TRANSFER OF ELECTRONIC INFORMATION IN A STANDARD FORMAT.58
14921721974ENCODERSOFTWARE THAT SUGGESTS CODES BASED ON DOCUMENTATION59
14921721975ENCOUNTERA DIRECT, PROFESSIONAL MEETING BETWEEN A PATIENT AND A HEALTH CARE PROFESSIONAL WHO IS LICENSED TO PROVIDE MEDICAL SERVICES.60
14921721976ENCOUNTER FORMFORM THAT INCLUDES INFORMATION ABOUT PAST HISTORY, CURRENT HISTORY, INPATIENT AND INSURANCE INFORMATION.61
14921721977EXPLANATION OF BENEFITS (EOB)DESCRIBES THE SERVICES RENDERED, PAYMENT COVERED AND BENEFIT LIMITS AND DENIALS.62
14921721978FAIR DEBT COLLECTION PRACTICES ACT (FDCPA)THIS LAW STATES THAT DEBT COLLECTORS CANNOT USE UNFAIR OR ABUSIVE PRACTICES TO COLLECT PAYMENTS.63
14921721979FALSE CLAIMS ACTTHE FALSE CLAIMS ACT PROTECTS THE GOVERNMENT FROM BEING OVERCHARGED FOR SERVICES PROVIDED OR SOLD, OR SUBSTANDARD GOODS OR SERVICES64
14921721980FORMULARYA LIST OF PRESCRIPTION DRUGS COVERED BY AN INSURANCE PLAN65
14921721981FRAUDMAKING FALSE STATEMENTS OR REPRESENTATIVES OF MATERIAL FACTS TO OBTAIN SOME BENEFIT OR PAYMENT FOR WHICH NO ENTITLEMENT EXISTS.66
14921721982PCPPRIMARY CARE PHYSICIAN67
14921721983GATEKEEPERPRIMARY CARE PHYSICIAN68
14921721984HEALTH MAINTENANCE ORGANIZATION (HMO)PLAN THAT ALLOWS PATIENTS TO ONLY GO TO PHYSICIANS, OTHER HEALTH CARE PROFESSIONALS, OR HOSPITALS ON A LIST OF APPROVED PROVIDERS EXCEPT FOR EMERGENCY.69
14921721985HEALTH RECORD NUMBERNUMBER THE PROVIDER USES TO IDENTIFY AN INDIVIDUAL PATIENT'S RECORD70
14921721986IMPLIED CONSENTA PATIENT PRESENTS FOR TREATMENT, SUCH AS EXTENDING AN ARM TO ALLOW A VENI-PUNCTURE TO BE PERFORMED71
14921721987INFORMED CONSENTPROVIDERS EXPLAIN MEDICAL OR DIAGNOSTIC PROCEDURES, SURGICAL INTERVENTION, AND THE BENEFITS AND RISKS INVOLVED, GIVING PATIENTS AN OPPORTUNITY TO ASK QUESTIONS BEFORE MEDICAL INTERVENTION IS PROVIDED.72
14921721988MEDICAIDA GOVERMENT BASED HEALTH INSURANCE OPTION THAT PAYS FOR MEDICAL ASSISTANCE FOR INDIVIDUALS WHO HAVE LOW INCOMES AND LIMITED FINANCIAL RESOURCES. FUNDED AT THE STATE AND NATIONAL LEVEL. ADMINISTERED AT THE STATE LEVEL.73
14921721989MEDICARE ADMINISTRATIVE CONTRACTOR (MAC)PROCESS MEDICARE PARTS A & B CLAIMS FROM HOSPITALS, PHYSICIANS, AND OTHER PROVIDERS.74
14921721990MEDICARE PART AHOSPITALIZATION COVERAGE FOR ELIGIBLE INDIVIDUALS75
14921721991MEDICARE PART BALL PROFESSIONAL SERVICES76
14921721992MEDICARE PART CCOMBINATION PART A & B77
14921721993MEDICARE PART DPRESCRIPTION COVERAGE78
14921721994MEDICARE SUMMARY NOTICEDOCUMENT THAT OUTLINES THE AMOUNT BILLED BY THE PROVIDER AND WHAT THE PATIENT MUST PAY THE PROVIDER79
14921721995MEDICAREFEDERALLY FUNDED HEALTH INSURANCE PROVIDED TO PEOPLE AGE 65 OR OLDER, PEOPLE YOUNGER THAN 65 WHO HAVE CERTAIN DISABILITIES, AND PEOPLE OF ALL AGES WITH END-STAGE KIDNEY DISEASE. FUNDED AND ADMINISTERED AT THE NATIONAL LEVEL.80
14921721996MEDIGAPA PRIVATE HEALTH INSURANCE THAT PAYS FOR MOST OF THE CHARGES NOT COVERED BY A & B.81
14921721997MODIFIERADDITIONAL INFORMATION ABOUT TYPES OF SERVICES, AND PART OF A VALID CPT OR HCPCS CODES.82
14921721998MORBIDITYTHE NUMBER OF CASES OF DISEASE IN A SPECIFIC CONDITION83
14921721999MORTALITYTHE INCIDENCE OF DEATH IN A SPECIFIC POPULATION84
14921722000MS-DRG GROUPERSOFTWARE THAT HELPS CODERS ASSIGN THE APPROPRIATE MEDICARE SEVERITY DIAGNOSIS - RELATED GROUP BASED ON THE LEVEL OF SERVICES PROVIDED, SEVERITY OF THE ILLNESS OR INJURY, AND OTHER FACTORS.85
14921722001NATIONAL PROVIDER IDENTIFIER - NPIUNIQUE 10-DIGIT CODE FOR PROVIDERS REQUIRED BY HIPAA86
14921722002NPINATIONAL PROVIDER IDENTIFIER87
14921722003NOTICE OF EXCLUSIONS FROM MEDICARE BENEFITSNOTIFICATION BY THE PHYSICIAN TO A PATIENT THAT A SERVICE WILL NOT BE PAID88
14921722004NOTICE OF PRIVACY PRACTICESTHE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) PRIVACY RULES GIVES INDIVIDUALS A RIGHT TO BE INFORMED OF THE PRIVACY PRACTICES OF THEIR HEALTH PLANS AND OF MOST OF THEIR HEALTH CARE PROVIDERS, AS WELL AS TO BE INFORMED OF THEIR INDIVIDUAL RIGHTS WITH RESPECT TO THEIR PROTECTED HEALTH INFORMATION. (PHI)89
14921722005OFFICE OF THE INSPECTOR GENERALTHE OFFICE OF THE INSPECTOR GENERAL PROTECTS MEDICARE AND OTHER HHS PROGRAMS FROM FRAUD AND ABUSE BY CONDUCTING AUDITS, INVESTIGATIONS AND INSPECTIONS90
14921722006PPOARE MORE FLEXIBLE THAN AN HMO AND HAVE BROADER RANGE OF REQUIREMENTS FOR SERVICES91
14921722007PREAUTHORIZATIONAPPROVAL FROM THE INSURANCE COMPANY FOR AN INPATIENT HOSPITAL STAY OR SURGERY92
14921722008PRECERTIFICATIONA REVIEW THAT LOOKS AT WHETHER THE PROCEDURE COULD BE PERFORMED SAFELY BUT LESS EXPENSIVELY IN A OUTPATIENT SETTING93
14921722009PREDETERMINATIONA WRITTEN REQUEST FOR A VERIFICATION OF BENEFITS94
14921722010PROTECTED HEALTH INFORMATION (PHI)IS ANY INFORMATION ABOUT HEALTH STATUS, PROVISION OF HEALTH CARE, OR PAYMENT FOR HEALTH CARE THAT CAN BE LINKED TO A SPECIFIC INDIVIDUAL.95
14921722011RARC'SREMITTANCE ADVICE REASON CODES96
14921722012REFERRALWRITTEN RECOMMENDATION TO A SPECIALIST97
14921722013REIMBURSEMENTPAYMENT FOR SERVICES RENDERED FROMA THIRD PARTY PAYER98
14921722014REMITTANCE ADVICE (RA)THE REPORT SENT FROM THIRD PARTY PAYER TO THE PROVIDER THAT REFLECTS ANY CHANGES MADE TO THE ORIGINAL BILLING99
14921722015STARK LAWTHE STARK LAW IS A LIMITATION ON CERTAIN PHYSICIAN REFERRALS. IT PROHIBITS PHYSICIAN REFERRALS OF DESIGNATED HEALTH SERVICES FOR MEDICARE AND MEDICAID PATIENTS IF THE PHYSICIAN (OR AN IMMEDIATE FAMILY MEMBER) HAS A FINANCIAL RELATIONSHIP WITH THAT ENTITY100
14921722016SUBSCRIBER NUMBERUNIQUE CODE USED TO IDENTIFY A SUBSCRIBERS POLICY.101
14921722017SUBSCRIBERPURCHASER OF THE INSURANCE OR THE MEMBER OF A GROUP FOR WHICH AN EMPLOYER OR ASSOCIATION AS PURCHASED INSURANCE102
14921722018THIRD PARTY PAYERORGANIZATION OTHER THAN A PATIENT WHO PAYS FOR SERVICES, SUCH AS INSURANCE COMPANIES, MEDICARE AND MEDICAID103
14921722019TIER 1PROVIDERS AND FACILITIES IN A PPO NETWORK104
14921722020TIER 2PROVIDERS AND FACILITIES WITHIN A BROADER CONTRACTED NETWORK OF THE INSURANCE COMPANY105
14921722021TIER 3PROVIDERS AND FACILITIES OUT OF NETWORK106
14921722022TIER 4PROVIDERS AND FACILITIES NOT ON THE FORMULARY107
14921722023TIMELY FILINGWITHIN ONE CALENDAR YEAR OF A CLAIMS DATE OF SERVICE108
14921722024TPOTREATMENT, PAYMENT, AND OR HEALTHCARE OPERATIONS109
14921722025UNBUNDLINGUSING MULTIPLE CODES THAT DESCRIBE DIFFERENT COMPONENTS OF A TREATMENT INSTEAD OF USING A SINGLE CODE THAT DESCRIBES ALL STEPS OF THE PROCEDURE110
14921722026UPCODINGASSIGNING A DIAGNOSIS OR PROCEDURE CODE AT A HIGHER LEVEL THAN THE DOCUMENTATION SUPPORTS, SUCH AS111
14921722027VICARIOUS LIABILITYREFERS TO A SITUATION WHERE SOMEONE IS HELD RESPONSIBLE FOR THE ACTIONS OR OMISSIONS OF ANOTHER PERSON.112
14921722028WRITE-OFFTHE DIFFERENCE BETWEEN THE PROVIDER'S ACTUAL CHARGE AND THE ALLOWABLE CHARGE113

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