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CertReview1 3/10

Quiz 1

Evaluation and Management 99201-99499
Anesthesia 00100-01999, 99100-99140
Surgery 10021-69990
Radiology 70010-79999
Pathology and Laboratory 80047-89398
Medicine (excluding Anesthesia) 90281-99199, 99500-99607
abstracting The extraction of specific data from a medical record, often for use in external database, such as a cancer registry
abuse Practices that directly or indirectly result in unnecessary costs to the Medicare program
account number Number that identifies specific episode of care, date of service, or patient
accounts receivable department Department that keeps track of what third-party payer the provider is waiting to hear from and what patients are due to make a payment
activity/status date Indicates the most recent activity of an item
actual charge The amount the provider charges for the health care service
Administration Simplification Compliance Act (ASCA) Specifically prohibits any payment by Medicare for services or medically necessary supplies that are not submitted electronically
administrative services only (ASO) contract Contract between employers and private insurers under which employers fund the plans themselves, and the private insurers administer the plans for the employer
Advanced Beneficiary Notice of Noncoverage Form provided if a provider believes that a service may be declined because Medicare might consider it unnecessary
aging report Measures the outstanding balances in each account
allowable charge The amount an insurer will accept as full payment, minus applicable cost sharing
APC grouper Helps coders determine the appropriate ambulatory payment classification (APC) for an outpatient encounter
assignment of benefits Contract in which the provider directly bills the payer and accepts the allowable charge
auditing Review of claims for accuracy and completeness
Created by: sbogle



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