Busy. Please wait.

show password
Forgot Password?

Don't have an account?  Sign up 

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.
We do not share your email address with others. It is only used to allow you to reset your password. For details read 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.
Don't know
remaining cards
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

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

wk4 InsTerms/Acronym

accept assignment provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and/ or coinsurance amounts.)
allowed charges the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy.
assignment of benefits the provider receives reimbursement directly from the payer
beneficiary the person eligible to receive health care benefits
birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan
charge master document that contains a computer generated list of procedures, services, and supplies with charges for each; charge master data are entered in the facility's patient accounting system, and charges are automatically posted to the patient's bill
adjudication judicial dispute resolution process in which an appeals board makes a final determination
appeal documented as a letter, signed by the provider, explaining why a claim should be reconsidered for payment
clean claim a correctly completed standardized claim (e.g., CMS-1500 claim).
clearinghouse performs centralized claims processing for providers and health plans
downcoding assigning lower-level codes than documented in the record
guarantor person responsible for paying health care fees
litigation legal action to recover a debt; usually a last resort for a medical practice
MAC Medicare administrative contractor
Medi-Medi Medicare/Medicaid crossover
MPFS Medicare Physician Fee Schedule
MS-DRG Medicare severity diagnosis-related group
nonPAR non participating provider
NPI National Provider Identifier
OBRA Omnibus Budget Reconciliation Act of 1981
OSHA Occupational Safety and Health Administration
OWCP Office of Workers Compensation Program
PAR Participating Provider
PCP Primary Care Provider
PHI Protected Health Information
PIN Provider Identification Number
POS Place of Service
PPO Preferred provider organization
RBRVS resource based relative value system
RVU relative value unit
SOAP subjective, objective, assessment, plan
Created by: cheri le