Chapter 1 Medical Billing and Coding Flashcards

13246901143	American Association of Medical Assistants (AAMA):	Enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants' right to practice.	0
13246909150	Centers for Medicare and Medicaid Services (CMS)	Formerly known as the Health Care Financing Administration (HCFA); an administrative agency within the federal Department of Health and Human Services (DHHS).	1
13246918898	Coding	Process of reporting diagnosis, procedures, and services as numeric and alphanumeric characters (called codes) on the insurance claim	2
13246928107	Current Procedural Terminology (CPT)	Published by the American Medical Association; includes five-digit numeric codes and descriptors for procedures and services performed by providers.	3
13246936923	Department of Health and Human Services (DHHS)	The United States government's principal agency for "protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves	4
13246943248	Embezzle	The illegal transfer of money or property as a fraudulent action; to steal money from an employer.	5
13246950961	Ethics	Principal of right or good conduct; rules that govern the conduct of members of a profession	6
13246959948	Explanation of benefits (EOB)	Report that details the results of processing a claim.	7
13246968818	HCPCS level II codes	: National codes published by CMS, which include five-digit alphanumeric codes for procedures, services, and supplies not classified in CPT.	8
13246976915	Health insurance claim	documentation of submitted to an insurance plan requesting reimbursement for health care services provided.	9
13246986941	Hold harmless cause	Policy that the patient is not responsible for paying what the insurance plan denies.	10
13246995576	International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)	Coding system to be implemented October 1, 2015, and used to report diseases, injuries, and other reasons for inpatient and outpatient encounters	11
13247008202	International Classification of Diseases, 10th Revision, Procedural Coding System (ICD-10-PCS):	Coding system to be implemented on October 1, 2015 and used to report procedures and services on impatient claims.	12
13247015761	Medical Malpractice Insurance	A type of liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatment.	13
13247023393	Medical necessity	involves linking every procedure or service code reported on an insurance claim to a condition code that justifies the need to perform that procedure or service.	14
13247029791	National Codes	Commonly referred to as HCPCS level II codes; include five-digit alphanumeric codes for procedures, services, and supplies that are not classified in CPT.	15
13247036272	Preauthorization	Health plan review that grants prior approval health care services	16
13247042285	Professionalism	Conduct or qualities that characterize a professional person	17
13247051887	Remittance advice (remit)	Electronic or paper-based report of payment sent by the payer to the provider; includes patient name, patient health insurance claim (HIC) number, facility provider number/name, dates of service (from date/thru date), type of bill (TOB), charges, payment information, and reason and/or remark codes	18
13247056561	Respondeat Superior	Latin for "let the master answer"; legal doctrine holding that the employer is liable for the actions and omissions of employees performed and committed within the scope of their employment	19
13247063068	Scope of Practice	Health care services, determined by the state, that an NP and PA can perform.	20