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CertReview3 3/17
Quiz 3
| Term | Definition |
|---|---|
| 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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