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KDuvall
Health Insurance Chapter 1
| Question | Answer |
|---|---|
| An insurance agreement that guarentees repayment for financial losses resulting from an employee's act or failure to act. Protects employers financial operations. | Bonding Insurance |
| The administrative agency within the federal department of health and human services. | Centers for Medicare and Medicaid Services |
| Published by the AMA and includes 5 digit numeric and alphanumeric codes and descriptions for procedures and services | Current Procedural Terminology (CPT) |
| Mutual exchange of data between the provider and insurance company | Electronic Data Interchange (EDI) |
| Provides protection from claims that contain errors and omissions resulting from professional services provided to clients (also called professional liability insurance) | Errors and Omissions Insurance |
| The principles of right and or good conduct | Ethics |
| A report detailing the results of processing a claim | Explanation of benefits |
| Published by CMS, and include 5 digit numeric and alphanumeric codes for procedures, services,and supplies not classified in CPT | HCPCS Level II Codes (aka-National Codes) |
| COnsists of two levels: Current Procedural Terminology, and National Codes (or HCPCS Level II codes) | Healthcare Common Procedure Coding System |
| The healthcare provider cannot collect the fees from the patient | Hold Harmless Clause |
| A person who performs services for another under an express or implied agreement and who is not subject to the other's control, or right to control. | Independent Contractor |
| Linking every procedure or service code reported on the claim to an ICD-9 condition code t hat justifies the necessity for performing that procedure or service | Medical Necessity |
| Prior approval for treatment | Preauthorization |
| Protects business assets and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising | Professional Liability Insurance |
| A notice sent by the insurance company that contains payment information about a claim | Remittance Advice |
| The documentation submitted to the payer requesting reimbursement is called a... | Health Insurance Claim |
| The Centers for Medicare and Medicaid Services (CMS) was previously called the.... | Health Care Financing Administration |
| A health care practitioner is also calle a... | Provider |
| The mutual exchange of data between provider and payer is called... | Electronic Data Interchange |
| The process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters is called.... | Coding |
| If the health plan preauthorization requirements are not met by providers,.. | Payment of the Claim is denied |
| Which coding system is used to report diagnosis and conditions on claims? | ICD |
| The CPT coding system is published by the... | AMA |
| National codes are associated with... | HCPCS |
| Which report is sent to the patient to detail the results of claims processing? | Explanation of Benefits |
| A remittance advice contains... | Payment information about a claim |
| Which type of insurance guarantees repayment of financial loss resulting from an employee's act or failure to act? | Bonding |
| Medical malpractice insurance is a type of what insurance? | Liability |
| Which mandates workers' compensation insurance to cover employees and their dependenat against injury and death occurring during the course of employment? | State |
| The American Medical Billing Association offers which certification exam? | CMRS |
| The concept that every procedure or service reported to a third-party payer must be linked to a condition that justifies that procedure or service is called? | Medical Necessity |
| The administrative agency responsible for establishing rules for Medicare claims processing is called the..... | Centers for Medicare and Medicaid Services |
| Documentation submitted to an insurance company requesting reimbursement for health care services provided is called a.... | Health Insurance Claim |
| Which organization is responsible for administering the Certified Healthcare Reimbursement Specialist certification exam? | AMBA |
| Which clause is implemented if the requirements associated with preauthorization of a claim prior to payment are not met? | Hold Harmless Clause |
| Data published in the Occupational Outlook Handbook indicates the job opportunities for health insurance specialists will increase by what percentage? | 9-17 percent |
| The exchange of information between provider and third-party payer, using a standardized machine-readable format, is called.... | Electronic Data Interchange |
| The process of reporting diagnoses, procedures and services as numeric and alphanumeric characters on an insurance claim is.... | Coding |
| Which is another title for the health insurance specialist? | Claims Examiner |
| Which type of insurance should be purchased by health insurance specialist independent contractors? | Medical Malpractice |
| A health insurance specialist who is able to demonstrate cometency in facilitating the claims reimbursement process from the time a service is rendered by a provider until the balance is paid can qualify for which certification? | Certified Medical Reimbursement Specialist (CMRS) |
| Which certification fulfills the need for an entry-level coding credential? | Certified Coding Assistant (CCA) |
Created by:
kduvall20
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