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CertReview2 3/15
Quiz 2
| Term | Definition |
|---|---|
| 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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