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Chapter 2 Key Terms

Medical Billing

administrative safeguards administrative policies and procedures designed to protect electronic health information outlined by the HIPAA Security Rule.
audit/edit report a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer
audit trail a report that traces who has accessed electronic information, when information was accessed, and whether any information was changed
autoposting an automated process for entering information on a remittance advice (RA) into a computer
clearinghouse a service company that receives electronic or paper claims from the provider, checks and prepares them for processing, and transmits them in HIPAA-compliant format to the correct carriers
CMS-1500 (08/05) The currently mandated paper form for health care claims
electronic data interchange (EDI) the exchange of routing business transactions from one computer to another using publicly available communications protocols
electronic funds transfer (EFT) a system that transfers money electronically
electronic medical record (EMR) electronic collection and management of health data
electronic prescribing the use of computers and handheld devices to write and transmit prescriptions to a pharmacy in a secure digital format
HIPAA (Health Insurance Portability and Accountability Act of 1996) federal act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information.
HIPAA Electronic Transaction and Code Sets Standards regulations requiring electronic transactions such as claim transmission to use standardized formats
HIPAA Privacy Rule regulations for protecting individually identifiable information about a patient's past, present, or future physical and mental health and payment for health care that is created or received by a health care provider
HIPAA Security Rule regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information
information technology (IT) development, management, and support of computer-based hardware/software systems
National Provider Identifier (NPI) a standard identifier for all health care providers consisting of ten numbers
physical safeguards mechanisms required to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrustion
protected health information (PHI) information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person
technical safeguards automated processes used to protect data and control access to data
walkout statement a document listing charges and payments that is given to a patient after an office visit
X12-837 Health Care Claim (837P) HIPAA standard format for electronic transmission of a professional claim from a provider to a health plan