Quiz 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| authorization | Permission granted by the patient or the patients representative to release information for reasons other than treatment, payment, or health care operations
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| balance billing | Billing patients for charges in excess of the Medicare fee schedule
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| batch | A group of submitted claims
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| Blue Cross and Blue Shield plan | The first prepaid plan in the U.S. that offers health insurance to individuals, small businesses, seniors, and large employer groups
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| business associate (BA) | Individuals, groups, or organizations who are not members of a covered entity's workforce that perform functions or activities on behalf of or for a covered entity
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| capitation | the fixed amount a provider receives
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| case management | A review of clinical services being performed
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| Category I CPT code | Code that covers physicians' services and hospital outpatient coding
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| Category II CPT code | Code designed to serve as supplemental tracking codes that can be used for performance measures
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| Category III CPT code | Code used for temporary coding for new technology and services that have not met requirements needed to be added to the main section of the CPT book
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| charge amount | The amount the facility charges for the procedure or service
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| charge description master (CDM) | Information about health care services that patients have received and financial transactions that have taken place
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| charge or service code | Internally assigned number unique to each facility
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| claim | A complete record of services provided by health care professional, along with appropriate insurance information, submitted for reimbursement to a third-party payer
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| claims adjustment reason code (CARC) | Provides financial information about claims decisions
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| claim scrubber | Software that reviews a claim prior to submission for correct and complete data, such as accurate gender in alignment with diagnosis/procedure or medical necessity
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| clean claim | claim that is accurate and complete. They have all the information needed for processing, which is done in a timely fashion
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| clearinghouse | Agency that converts claims into a standardized electronic format, looks for errors, and formats them according to HIPPA and insurance standards
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| clinical documentation | The record of clinical observations and care a patient receives at a health care facility
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| commercial documentation | The record of clinical observations and care a patient receives at a health care facility
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Or sort by any of the columns using the down arrow next to any column heading.
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Created by:
sbogle
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