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CertReview2 3/15

Quiz 2

authorization Permission granted by the patient or the patients representative to release information for reasons other than treatment, payment, or health care operations
balance billing Billing patients for charges in excess of the Medicare fee schedule
batch A group of submitted claims
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
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
capitation the fixed amount a provider receives
case management A review of clinical services being performed
Category I CPT code Code that covers physicians' services and hospital outpatient coding
Category II CPT code Code designed to serve as supplemental tracking codes that can be used for performance measures
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
charge amount The amount the facility charges for the procedure or service
charge description master (CDM) Information about health care services that patients have received and financial transactions that have taken place
charge or service code Internally assigned number unique to each facility
claim A complete record of services provided by health care professional, along with appropriate insurance information, submitted for reimbursement to a third-party payer
claims adjustment reason code (CARC) Provides financial information about claims decisions
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
clean claim claim that is accurate and complete. They have all the information needed for processing, which is done in a timely fashion
clearinghouse Agency that converts claims into a standardized electronic format, looks for errors, and formats them according to HIPPA and insurance standards
clinical documentation The record of clinical observations and care a patient receives at a health care facility
commercial documentation The record of clinical observations and care a patient receives at a health care facility
Created by: sbogle



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