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CBCS Exam Words

Definitions for CBCS Exam

TermDefinition
Medical Ethics a system of moral principals that apply values to the practice of clinical medicine and in scientific research.
Accounts Payable (A/P)monies being paid from the medical practice, for instance to pay for supplies, rent, utilities, payroll, etc.
Accounts Receivable (A/R)monies or funds that are owed to the practice for services provided.
Accounts Receivable Department department that keeps track of what third-party payers the provider is waiting to hear from and what patients are due to make a payment.
Aging Report a review, usually done with a computer program, of any monies owed to the health care provider and any reason for lack of payment; used to keep track of delayed receivables
Aged Trial Balance (ATB) alphabetically lists accounts receivable with outstanding balances. It displays 1 balance for every account by age and is typically produced only once on demand to check receivable details against other reports.
Roster Billing simplified process that was developed to enable Medicare beneficiaries to participate in mass pneumococcal pneumonia virus (PPV) and influenza virus vaccination programs offered by public health clinics.
Fraud making false statements of representation of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
Abuse practices that directly or indirectly result in unnecessary costs to the Medicare program.
Minimum Necessary Standard only disclose/release information that is necessary.
Regulatory Compliance When a business follows state, federal, and International laws and regulations relevant to its operations.
Unbundling using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.
Upcoding assigning a diagnosis or procedure code at a "higher level then the level that the document supports, such as coding.
Use a covered entity or BA handling PHI internally.
Documentation the record of clinical observations and care a patient receives at a health care facility.
Disclosure communicating confidential patient information to others in accordance with legal guidelines, given to an outside person or organization.
Managed Care refers to solutions that help to save money on healthcare while providing better services for patients. Also focuses on prevention and management of resources and unification to help patients while reigning in costs.
Ordering Provider a physician or other licensed health care professional, such as a physician assistant or nurse practitioner, who prescribes services for a patient.
Referring Provider the physician or other licensed health care professional who requests a service for a patient.
Supervising Provider the physician monitoring a patient's care.
Rendering Provider the person or company (laboratory or other facility) who rendered the care.
Primary Care Physician (PCP) often acts as gatekeeper.
Gatekeeper person who coordinates care in a managed care plan. Usually the PCP in an HMO plan. Provider who determines the appropriateness of the health care service, level of health care professional called for, and setting for care.
Formulary list of prescription drugs covered by an insurance plan.
(Least expensive) generic or not covered by a patent Tier 1
Non-generic with preferred brand name Tier 2
Prescription with non-preferred brand name Tier 3
Not on formulary Tier 4
Providers, facilities, and prescription drugs in a PPO network. Tier 1
Providers, facilities, and prescription drugs within a boarder, contracted network of the insurance company. Tier 2
Providers, facilities, and prescription drugs out of the network. Tier 3
Providers, facilities, and prescription drugs not on the formulary. Tier 4
Medical Assistant (MA) performs administrative and clinical tasks to keep office running smoothly; can perform basic function of medical billing and coding; work closely with providers, patients, administrative staff, and other health care professionals like RNs.
Medical Administrative Assistant responsible for providing administrative support to providers an other health care professionals; perform general office tasks and are able to perform basic billing and coding functions, formerly known as secretaries and receptionists.
Licensed Practical Nurse (LPN) able to perform functions similar to an RN, BUT under the direct supervision of an RN; can work in hospitals or other specialized settings such as nursing homes, providers offices, or home health care.
Registered Nurse (RN) legally authorized/registered to practice after passing exam given by state board, nurse examiners, or similar regulatory authority; liaison between patient, provider, medical assistant (MA), and often billing and coding specialist.
Referring Physician refers patients for services or supplies they cannot provide.
Resident Physician has finished medical school and internship and is currently training in a specialized area.
Case Manager a review of clinical services being provided.
Claim Scrubber software that reviews a claim prior to submission for correct and complete data, such as accurate gender in alignment with diagnosis/procedure or medical necessity.
Computer-assisted coding (CAC) software that scans the entire patient's electronic record and codes the encounter based on the documentation in the record.
E Codes External Cause of Injury codes (ICD-9 specific)- used to classify environmental events, circumstances, and conditions, such as the cause of injury, poisoning, and other adverse events.
Utilization Review A process to determine medical necessity of a particular procedure or service, designed to ensure that the procedure or service is appropriate and is being provided in the most cost-effective way.
V Codes "Supplementary Classification of Factors Influencing Health Status and Contact with Health Services," ICD-9-CM, designed for occasions when things other than disease/injury result in encounter or recorded as problems or factors that influence care.
Created by: cattomko
 

 



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