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Health Ins and Claims Chapter 1

AAPC American Academy of Professional Coders (
AHIMA American Health Information Management Association
This insurance agreement guarantees repayment for financial losses resulting from an employee's act or failure to act. bonding insurance
What is the name of the administrative agency within the federal Department of Health and Human Services formerly called HCFA? Centers for Medicare and Medicaid Services (CMS)
Alphanumeric codes and descriptors for procedurea nad services performed by providers Current Procedural Terminology (CPT)
Mutual electronic exchange of data between the provider and insurance company electronic data interchange (EDI)
What is another term for professional liability insurance? errors and omissions insurance
The principles of right or good conduct, and rules that govern the conduct of members of a profession. ethics
What report detailing the results of processing a claim does the patient receive? explanation of benefits (EOB)
Five-digit alphanumeric codes for procedures, services, and supplies not classified in CPT. HCPCS level II codes
HCPCS Healthcare Common Procedure Coding System
If the insurance plan has this in their contract the patient is not responsible for paying what the insurance plan denies. hold harmless clause
A person who performs services for another under an express or implied agreement and who is not subject to the other's control, or right to control, of the manner and means of performing the services. independent contractor
prior approval for treatment by specialist and documentation of post-treatment reports is called what? preauthorization
What insurance provides protection from claims that contain errors and omissions resulting from professional services provided to clients as expected of a person in the contractor's profession? professional liability insurance
What report detailing the results of processing a claim is received by the provider? remittance advice (remit)
What is it called when you link every procedure or service code reported on the claim to an ICD-9-CM condition code that justifies the necessity for performing that procedure or service? medical necessity
HCPCS consists of how many levels? two: level 1 CPT; level II national codes
Created by: Kcompleta