Busy. Please wait.
Log in using Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

CertReview6 3/29

Quiz 6

patient responsibility The amount the patient owes
preauthorization The health plan is notified that a hospital stay or significant procedure is coming up, giving the plan the opportunity to determine if it is medically necessary and in case of an inpatient admission, how many days the patient most likely will stay
precertification A review that looks at whether the procedure could be performed safely but less expensively in an outpatient setting
predetermination A written request for a verification of benefits
preferred provider organization (PPO) Plan that allows patients to use physicians, specialist, and hospitals in plan's network
primary insurance Insurance that pays first, up to the limits of its coverage
prior approval number Number indicating that the insurance company has been notified and has approved services before they were rendered
Privacy Rule A HIPPA rule that establishes protections for the privacy of individual's health information
private-fee-for-service plan Plan that allows patients to go to any physician, other health care professional, or hospital as long as the providers agree to treat those patients
protected health information (PHI) Individually identifiable health information
provider-level adjustment reason code Codes that are not related to a specific claim
referral Written recommendations to a specialist
referring provider The physician or other licensed health care professional who requests a service for a patient
reimbursement Payment for services rendered from a third-party payer
remittance advice (RA) The report sent from the third-party payer to the provider that reflects any changes made to the original billing
remittance advice remark code (RARC) Code that explains the reason for a payment adjustment
revenue code Four-digit code that identifies specific accommodation, ancillary service, or billing calculation related to services on a bill
staff model HMO that provides hospitalization and physician services through its own staff
Stark Law Physicians are not allowed to refer patients to a practitioner with whom they have a financial relationship
Created by: sbogle



Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards