Busy. Please wait.

Forgot Password?

Don't have an account?  Sign up 

show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.

By signing up, I agree to StudyStack's Terms of Service and Privacy Policy.

Already a StudyStack user? Log In

Reset Password
Enter the email address associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know (0)
Know (0)
remaining cards (0)
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how


SBGR ALH 151 Week 5 Ch 18 & 19 Pearson's (2012 EK)

assignment of benefits patient's written authorization giving the insurance company the right to pay the physician directly for billed charges
birthday rule used by insurance claim administrators to determine which parent's benefit plans will pay for the medical bills of a dependent child when the child is covered by the plans of both parents
breach of confidentiality failure to keep patient information confidential; occurs when patient information is released to others without authorization from the patient
clean claim health insurance claim form that has been completed correctly without any errors or omissions
clearinghouse independent entity that reviews claims, requests clarification from the provider, and "clean" claims ensuring accurate information is documented, then submits claims to insurance companies in proper format.
CMS-1500 most common health insurance claim form used to file claims for physician's services
Denied claim occurs when procedures or services are not covered by the patient's insurance policy or when the patient has not met his/her deductible
dirty claim a health insurance claim form that is incorrect because it has missing data or has errors
invalid claim health insurance claim form that has been completed but contains some type of incorrect information
nonparticipating provider a physician to whom the patient is expected to pay charges before submitting that claim to the insurance company, which pays the patient directly
primary insurance medical insurance coverage provided through tte patient''s employer
secondary insurance when the patient has medical insuranc ethrough their owbn employer nd thepatient's spouse also has medical insurance through their employer the insurance coverage throughout the spouse is considered secondary.
write-off to agree to forfeit the amount the insurance
Current Procedural Terminology (CPT) code book for procedures and services performed by physicians
established patient one who has been seen within the past 3 years by any practitioner
Evaluation and Management (E/M) codes for services such as office visits, consultations, the physician's component the emergency services and inpatient care
International Classification of Diseases, Ninth Revision, Clinical Modification ICD-9-CM: the code book for diagnosed diseases
International Classification of Diseases, Tenth Revision (ICD-10) most recent edition of the code book for diagnosed diseases
kickback incentive provided by physicians, laboratories, hospitals, or pharmaceutical representatives for use in their practices.
modifier two-digit code preceded by a hyphen that clarifies the procedure (e.g. a procedure that was done on both arms instead of only one.)
new patient patient who has never been seen by anyone in the practice, or who has not been seen by any practitioner of the same specialty in the same practice for more than 3 years.
principal diagnosis diagnosis of a particular condition for which a patient sought care on a particular date, suing when performing codidn in the hospital seetin gand whenn a final dianosis cannort be determined without futher patient follow-up
procedural coding
World Health Organization (WHO)
Created by: SBGrandRapids