Medical Billing & Coding Module 2 Flashcards

3627609655	Primary Insurance	is the insurance plan responsible for paying health care insurance claims first.	0
3627612834	Secondary Insurance	is the insurance plan that is billed after the primary insurance plan has paid its contracted amount (e.g., 80 percent of billed charges) and the provider's office has received a remittance advice from the primary payer.	1
3627649024	Encounter Form	is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current encounter.	2
3627653402	Claims Submission	is the electronic or manual transmission of claims data to payers or clearinghouses for processing.	3
3627660535	Value-Added Network	is a clearinghouse that involves value-added vendors, such as banks, in the processing of claims.	4
3627672006	Claims Attachment	is a set of supporting documentation or information associated with a health care claim or patient encounter.	5
3627675296	Coordination of Benefits (COB)	is a provision in group health insurance policies intended to keep multiple insurers from paying benefits covered by other policies; it also specifies that coverage will be provided in a specific sequence when more than one policy covers the claim.	6
3627678388	Claims Processing	involves sorting claims upon submission to collect and verify information about the patient and provider	7
3627723880	Deductible	is the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the insurance company is obligated to pay any benefits.	8
3627725297	Coinsurance	is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.	9
3627729601	Open Claims	are organized by month and insurance company and have been submitted to the payer, but processing is not complete.	10
3627731069	Closed Claims	are filed according to year and insurance company and include those for which all processing, including appeals, has been completed.	11
3627732475	Unassigned Claims	are organized by year and are generated for providers who do not accept assignment; the file includes all unassigned claims for which the provider is not obligated to perform any follow-up work.	12
3627735073	Pre-Existing Condition	is any medical condition that was diagnosed and/or treated within a specified period of time immediately preceding the enrollee's effective date of coverage.	13
3627737879	Accounts Receivable	are the amounts owed to a business for services or goods provided.)	14
3627755768	Medicare Drug Integrity Contractors (MEDIC) Program	implemented to assist with CMS audit, oversight, anti-fraud, and anti-abuse efforts related to the Medicare Part D benefit.	15
3627761123	Medical Review (MR)	is defined by CMS as a review of claims to determine whether services provided are medically reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions.	16
3627763816	Overpayments	are funds a provider or beneficiary receives in excess of amounts due and payable under Medicare and Medicaid statutes and regulations.	17
3627773169	Confidentiality	involves restricting patient information access to those with proper authorization and maintaining the security of patient information.	18
3627775827	Privacy	is the right of individuals to keep their information from being disclosed to others.	19
3627810168	Record Retention	is the storage of documentation for an established period of time, usually mandated by federal and/or state law.	20
3627817667	Participating Provider (PAR)	contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed.	21
3627830491	Clearinghouse	is a public or private entity that processes or facilitates the processing of nonstandard data elements (e.g., paper claim) into standard data elements	22
3627851611	Listserv	a subscriber-based question-and-answer forum available through e-mail.	23
3627926019	Release of Information Log	is used to document patient information released to authorized requestors, and data are entered manually (e.g., three-ring binder) or using ROI tracking software.	24
3627939327	Health Plan Identifier (HPID)	is assigned to third-party payers; it has 10 numeric positions, including a check digit as the tenth position.	25
3627953765	Privileged Communication	Any information communicated by a patient to a health care provider	26
3627959922	HIPAA Privacy Rule	creates national standards to protect individuals' medical records and other personal health information.	27
3627961981	HIPAA Security Rule	adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted electronically	28
3627964662	Release of information log	is used to document patient information released to authorized requestors, and data are entered manually (e.g., three-ring binder) or using ROI tracking software.	29