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Health Insurance
Health Insurance and Medical Billing!
| Question | Answer |
|---|---|
| independent contractor | Defined by the ‘Lectric Law Library’s Lexicon as “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. The |
| property insurance | Protects business contents (e.g., buildings and equipment) against fire, theft, and other risks |
| scope of practice | Health care services, determined by the state, that an NP and PA can perform |
| health information technician | Professionals who manage patient health information and medical records, administer computer information systems, and code diagnoses and procedures for health care services provided to patients |
| Centers for Medicare and Medicaid Services (CMS) | Formerly known as the Health Care Financing Administration (HCFA); an administrative agency within the federal Department of Health and Human Services (DHHS) |
| embezzle | the illegal transfer of money or property as a fraudulent action; to steal money from an employer |
| health care provider | Physician or other health care practitioner (e.g., physician’s assistant) |
| health insurance claim | Documentation that is electronically or manually submitted to an insurance plan requesting reimbursement for health care procedures and services provided (e.g., CMS-1500 and UB-04 claims) |
| bonding insurance | An insurance agreement that guarantees repayment for financial losses resulting from the act or failure to act of an employee. It protects the financial operations of the employer |
| AAPC | Professional association, previously known as the American Academy of Professional Coders, established to provide a national certification and credentialing process, to support the national and local membership by providing educational products and opport |
| health insurance specialist | Person who reviews health related claims to match medical necessity to procedures or services performed before payment (reimbursement) is made to the provider; see also reimbursement specialist |
| American Health Information Management Association (AHIMA) | Founded in 1928 to improve the quality of medical records, and currently advances the health information management (HIM) profession toward an electronic and global environment, including implementation of ICD-10-CM and ICD-10-PCS in 2013 |
| hold harmless clause | Policy that the patient is not responsible for paying what the insurance plan denies |
| respondeat superior | Latin for “let the master answer”; legal doctrine holding that the employer is liable for the actions and omissions of employees performed and committed within the scope of their employment |
| American Association of Medical Assistants (AAMA | Enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants’ right to practice |
| coding | Process of reporting diagnoses, procedures, services, and supplies as numeric and alphanumeric characters (called codes) on the insurance claim |
| electronic clinical quality measures (eCQMs) | processes, observations, treatments, and outcomes that quantify the quality of care provided by health care systems; measuring such data helps ensure that care is delivered safely, effectively, equitably, and timely |
| integrated delivery system (IDS) | organization of affiliated provider sites (e.g., hospitals, ambulatory surgical centers, or physician groups) that offer joint health care services to subscribers |
Created by:
cinthiajones31