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CertReview3 3/17

Quiz 3

computer-assisted coding (CAC) Software that scans the entire patient's electronic record and codes based on the documentation in the record
conditional payment Medicare payment that is recovered after primary insurance pays
contractual obligation Used when a contractual agreement resulted in an adjustment
coordination of benefits rules Determines which insurance plan is primary and which is secondary
cost sharing The balance the policyholder must pay to the provider
crossover claim Claim submitted by people covered by a primary and secondary insurance plan
deidentified information Information that does not identify an individual because unique and personal characteristics have been removed
demographic information Date of birth, sex, marital status address, telephone number, relationship to subscriber, and circumstances of condition
description of service An evaluation and management visit, observation, or emergency room visit
diagnosis code International Classification of Diseases (ICD-9-CM volumes 1 and 2; ICD-10-CM)
dirty claim Claim that is inaccurate, incomplete, or contains other errors
E codes Codes used to classify environment events, circumstances, and conditions, such as the cause of injury, poisoning, and other adverse events. Specific to ICD-9-CM
electronic data interchange (EDI) The transfer of electronic information in standard formation
employer-based self-insurance Insurance that is tied to an individual's place of employment
encoder Software that suggests codes based on documentation or other input
encounter form Form that includes information about past history, current history, inpatient record, discharge information, and insurance information
explanation of benefits (EOB) Describes the services rendered, payment covered, and benefits limits and denials
consent A patient's permission evidenced by signature
encounter A direct, professional meeting of a patient and health care professional who is licensed to provide medical service
correction and renewal Used for correcting a prior claim
Created by: sbogle



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