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Billing and Coding

Quiz 1

TermDefinition
Abuse An action that misuses money that the government has allocated, such as Medicare funds.
Audit Is a methodical examination, investigators review selected medical records to see whether the documentation matches the billing.
Authorization To release the information about substance (alcohol and drug) abuse, sexually transmitted diseases (STDs) or human immunodeficiency virus (HIV), and behavioral/mental health services may not be released without a specific authorization from the patient.
HIPPA The foundation legislation for the privacy of patients’ health information
Protected health information individually identifiable health information that is transmitted or maintained by electronic media, such as over the Internet, by computer modem, or on magnetic tape or compact disks.
Stark Law Make it illegal for physicians (or members of their immediate families) to have financial relationships with clinics to which they refer their patients, such as radiology service clinics and clinical laboratory services.
Birthday Rule This rule states that the parent whose day of birth is earlier in the calendar year is primary.
Gender Rule When this rule applies, if the child is covered by two health plans, the father’s plan is primary.
Coordination of Benefits that when a patient has more than one policy, maximum appropriate benefits are paid, but without duplication.
Guarantor the person who is financially responsible for the bill.
New Patient Is someone who has not received any services from the provider (or another provider of the same specialty/subspecialty) who is a member of the same practice within the past three years.
Referral Waiver Ensures that the patient will pay for services received if in fact a referral is not documented in the time specified.
Created by: marfor7046
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