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CBCS exam

CBCS Billing definitions and terms

What is the difference between co-pay and coinsurance? Coinsurance is a percentage and copay is a set amount
What is the definition of UCR? Amounts commonly charged for a service within a particular geographic region
What does EDI stand for? Electronic Data Interchange
What is capitation? Pre-established payments to providers for enrollees over a period of time, whether the patient is seen or not by the provider
What is the definition of "deductible"? The amount the patient is financially responsible before an insurance policy provides payment
What is the name of the standard claim form used to submit physician office services to Medicare and other insurance payors? CMS1500
What is an EOB? A report with details the results of processing a claim or called an Explanation of Benefits
What is RBRVS? Payment system for reimbursement of physician practice expenses base on the physician work, practice expense and malpractice insurance expense
What is the definition of a TPA? Company that provides health benefits claims administration, processes claims and other outsourcing services for self-insured companies
What does COB mean? Prevents multiple insurance plans from paying benefits covered by other plans when the patient has more than one policy
Created by: drea08