Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
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
Normal Size Small Size show me how
CertReview6 3/29
Quiz 6
| Question | Answer |
|---|---|
| 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
Popular Medical sets