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chapter 1
definitions
| Term | Definition |
|---|---|
| AAPC | AMERICAN ACADEMY OF PROFESSIONAL CODERS FOUNDED TO ELEVATE THE STANDARDS OF MEDICAL CODING BY PROVIDING CERTIFICATION,ONGOING EDUCATION,NETWORKING, AND RECOGNITION FOR CODERS |
| AAMA | AMERICAN ASSOCIATION OF MEDICAL ASSISTANTS ENABLES MEDICAL ASSISTING PROFESSIONALS TO ENHANCE AND DEMONSTRATE KNOWLEDGE, SKILLS, AND PROFESSIONALISM REQUIRED BY EMPLOYERS AND PATIENTS, AND PROTECTS MEDICAL ASSISTANTS' RIGHT TO PRACTICE |
| AHIMA | AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION FOUNDED IN 1928 TO IMPROVE THE QUALITY OF MEDICAL RECORDS, AND CURRENTLY ADVANCES THE HEALTH INFORMATIONN MANAGEMENT PROFESSION TOWARD AN ELECTRONIC AND GLOBAL ENVIRONMENT, INCLUDING IMPLEMENTATION OF IC |
| AMBA | AMERICAN MEDICAL BILLING ASSOCIATION PROVIDES INDUSTRY AND REGULATORY EDUCATION AND NETWORKING OPPORTUNITIES FOR MEMBERS |
| BONDING INSURANCE | AGREEMENT THAT GUARANTEES REPAYMENT FOR FINACIAL LOSSES RESULTING FROM AN EMPLOYEE'S ACT OR FAILURE TO ACT. PROTECTS THE FINANCIAL OPERATIONS OF THE EMPLOYER |
| BUSINESS LIABILITY INSURANCE | INSURANCE AGREEMENT THAT PROTECTS BUSINESS ASSETS AND COVERS THE COST OF LAWSUITS RESULTING FROM BODILY INJURY, PERSONAL INJURY, AND FALSE ADVERTISING |
| CMS | CENTERS FOR MEDICARE AND MEDICAID SERVCES ADMINISTRATED AGENCY WITHIN FEDRAL DEPARTMENT OF HEALTH AND HUMAN SERVICES |
| CLAIMS EXAMINER | EMPLOYED BY THIRD PARTY PAYER REVIEWS HEALTH RELATED CLAIMS TO DETERMINE WHETHER CHARGES ARE RESONABLE AND FOR MEDICAL NECESSITY |
| CODING | PROCESS OF REPORTING DIAGNOSES, PROCEDURES, AND SERVICES AS NUMERIC AND ALPHANUMERIC CHARACTERS ON THE INSURANCE CLAIM |
| CPT | CURRENT PROCEDURAL TERMINOLOGY |
| EMBEZZLE | ILLEGAL TRANSFER OF MONEY OR PROPERTY AS A FRAUDULENT ACTION |
| ERRORS AND OMISSIONS INSURANCE | PROFESSIONAL LIABILITY INSURANCE |
| ETHICS | PRINCIPLE OF RIGHT GOOD CONDUCT, AND RULES THAT GOVERN THE CONDUCT OF MEMBERS OF A PROFESSION |
| EOB EXPLANATION OF BENEFITS | REPORT DETAILING THE RESULTS OF PROCESSING A CLAIM |
| HCPCS LEVEL 2 CODES | DENTAL CODES, MISCELLANEOUS CODES, MODIFIERS, PERMANENT NATIONAL CODES,TEMPORARY CODES, ARE ATTACHED TO ANY HCPCS LEVEL 1 OR 2 CODE TO PROVIDE ADDITIONAL IFORMATION REGARDING THE PRODUCT OR SERVICE REPORTED:CONTAIN ALPHA OR ALPHANUMERIC CHARACTERS |
| HCPCS HEALTHCARE COMMON PROCEDURE CODING SYSTEM | CODING SYSTEM THAT CONSISTS OF CPT, NATIONAL CODES, AND LOVAL CODES |
| HEALTHCARE PROVIDER | PHYSICIAN OR OTHER HEALTHCARE PRACTITIONER |
| HEALTH INFORMATION TECHNICIAN | PROFESSIONALS WHO MANAGE PATIENT HEALTH INFORMATION AND MEDICAL RECORDS, ADMINISTER COMPUTER INFORMATION SYSTEMS, AND CODE DIAGNOSES AND PROCEDURES FOR HEALTHCARE SERVICES PROVIDED TO PATIENTS |
| HEALTH INSURANCE CLAIM | DOCUMENTATION SUBMITTED TO THIRD PARTY PAYER OR GOVERNMENT PROGRAM REQUESTING PAYMENT |
| HEALTH INSURANCE SPECIALIST | REVIEW HEALTH RELATED CLAIMS TO DETERMINE THE MEDICAL NECESSITY FOR PROCEDURES OR SERVICES PERFORMED BEFORE PAYMENT IS MADE TO PROVIDER |
| HOLD HARMLESS CLAUSE | PATIENT IS NOT RESPONSIBLE FOR PAYING WHAT THE INSURANCE PLAN DENIES |
| LIABILITY INSURANCE | POLICY THAT COVERS LOSSES TO A THIRD PARTY CAUSED BY THE INSURED, BY AN OBJECT OWNED BY THE INSURED, OR ON THE PREMISES OWNED BY THE SURED |
| MEDICAL ASSITANT | PERFORMS ADINISTRATIVE AND CLINICAL TASKS THAT KEEP THE OFFICE OR CLINIC RUNNING SMOOTHLY |
| MAB MEDICAL ASSOCIATION OF BILLERS | CREATED IN 1995 TO PROVIDE MEDICAL BILLING AND CODING SPECIALISTS WITH A RELIABLE SOURCE FOR DIAGNOSIS AND PROCEDURE CODING EDUCATION AND TRAINING |
| MEDICAL MALPRACTICE INSURANCE | TYPE OF LIABILITY INSURANCE, COVERS PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS FOR LIABILITY RELATING TO CLAIMS ARISING FROM PATIENT TREATMENT |
| MEDICAL NECESSITY | INVOLVES LINKIG EVERY PROCEDURE OR SERVICE CODE REPORTED ON AN ISURANCE CLAIM TO A CONDITION CODE THAT JUSTIFIES THE NEED TO PERFORM THAT PROCEDURE OR SERVICE |
| NATIONAL CODES | REFERED TO AS HCPCS CODES INCLUDE FIVE DIGIT ALPHANUMERIC CODES FOR PROCDURES, SERVICES,AND SUPPLIES THAT ARE NOT CLASSIFIED IN CPT |
| PREAUTHORIZATION | PRIOR APPROVAL |
| PROFESSIONAL LIABILITY INSURANCE | PROVIDES PROTECTION FROM CLAIMS THAT CONTAIN ERRORS AND OMISSIONS RESULTING FROM PROFESSIONAL SERVICES PROVIDED TO CLIENTS AS EXPECTED OF A PERSON IN THE CONTRACTOR'S PROFESSION |
| PROFESSIONALISM | CONDUCT OR QUALITIES THAT CHARACTERIZE A PROFESSIONAL PERSON |
| PROPERTY ISURANCE | AGREEMENT THAT PROTECTS BUSINESS CONTENTS AGAINST FIRE, THEFT, AND OTHER RISKS |
| REIMBURSEMENT SPECIALIST | HEALTH INSURANCE SPECIALIST |
| REMITTANCE ADVICE | NOTICE SEN BY THE INSURANCE COMPANY THAT CONTAINS PAYMENT INFORMATION ABOUT A CLAIM |
| RESPONDEAT SUPERIOR | EMPLOYER IS LIABLE FOR THE ACTIONS AND OMISSIONS OF EMPLOYEES AS PERFORMED AND COMMITED WITHIN THE SCOPE OF THEIR EMPLOYEMENT |
| SCOPE OF PRACTICE | DEFINES THE PROFESSION, DELINEATES QUALIFICATIONS AND RESPONSIBILITIES AND CLARIFIES SUPERVISION REQUIREMENTS |
| WORKERS' COMPENSATION INSURANCE | PROTECTION MANDATED BY STATE LAW THAT COVERS EMPLOYEES AND THEIR DEPENDENTS AGANST INJURY AND DEATH OCCURING DURING THE COURSE OF EMPLOYMENT |
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