Medical Billing & Coding Module 1 Flashcards

3627341544	Health Insurance Claim	is the documentation submitted to a third-party payer or government program requesting reimbursement for health care services provided.	0
3627349358	Medical Assistant	is employed by a provider to perform administrative and clinical tasks that keep the office or clinic running smoothly.	1
3627355136	Remittance Advice	which is a notice sent by the insurance company that contains payment information about a claim.	2
3627359148	Professional Liability Insurance	which provides protection from claims that contain errors and omissions resulting from professional services provided to clients as expected of a person in the contractor's profession.	3
3627363567	Professionalism	is the conduct, aims, or qualities that characterize a professional person.	4
3627368822	Third-party Payer	is a health insurance company that provides coverage, such as BlueCross BlueShield.	5
3627372030	Federal Employees' Compensation Act (FECA)	provides civilian employees of the federal government with medical care, survivors' benefits, and compensation for lost wages.	6
3627376423	Hill-Burton Act	provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and WWII (1929 to 1945).	7
3627380580	Copayment	is a provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service received.	8
3627383648	Clinical Laboratory Improvement Act (CLIA)	legislation established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regard- less of where the test was performed.	9
3627388707	National Correct Coding Initiative (NCCI)	created to promote national correct coding methodologies and to eliminate improper coding.	10
3627398968	Patient Protection and Affordable Care Act (PPACA)	focuses on private health insurance reform to provide better coverage for individuals with pre-existing conditions, improve prescription drug coverage under Medicare, and extend the life of the Medicare Trust fund by at least 12 years.	11
3627405540	Patient Record	documents health care services provided to a patient and includes patient demographic (or identification) data, documentation to support diagnoses and justify treatment provided, and the results of treatment provided.	12
3627413294	Electronic Health Record	is a more global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient.	13
3627426388	Preventive Services	which are designed to help individuals avoid health and injury problems.	14
3627432487	Individual Health Insurance	Private health insurance policy purchased by individuals or families who do not have access to group health insurance coverage.	15
3627433801	Public Health Insurance	Federal and state government health programs (e.g., Medicare, Medicaid, SCHIP, TRICARE) available to eligible individuals.	16
3627437426	Universal Health Insurance	The goal of providing every individual with access to health coverage, regardless of the system implemented to achieve that goal.	17
3627441919	Medical Savings Account	allows individuals to withdraw tax-free funds for health care expenses that are not covered by a qualifying high-deductible health plan	18
3627445610	Primary Care Provider (PCP)	is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists and inpatient hospital admissions	19
3627450545	Case Management	involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner.	20
3627474686	Exclusive Provider Organization (EPO)	is a managed care plan that provides benefits to subscribers who are required to receive services from network providers.	21
3627548519	Integrated Delivery System	is an organization of affiliated providers' sites (e.g., hospitals, ambulatory surgical centers, or physician groups) that offer joint health care services to subscribers.	22
3627551697	Health Maintenance Organization (HMO)	is an alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a prepaid basis.	23
3627556619	Accreditation	is a voluntary process that a health care facility or organization (e.g., hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.	24
3627582799	Preauthorization	is a review that grants prior approval for reimbursement of a health care service	25
3627584592	Concurrent review	is a review for medical necessity of tests and procedures ordered during an inpatient hospitalization	26
3627587368	Discharge planning	involves arranging appropriate health care services for the discharged patient	27
3627596293	Amendment to the HMO Act of 1973	Allowed federally qualified HMOs to permit members to occasionally use non-HMO physicians and be partially reimbursed	28
3627600581	HIPAA	The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created federal standards for insurers, HMOs, and employer plans, including those who self-insure.	29