Question 1

A participating physician’s agreement to accept the allowed charge as payment in full.

Accepted Answer

accept assignment 
(acceptance of assignment)

Question 2

Form accompanying a covered entity’s Notice of Privacy Practices; covered entities must make a good-faith effort to have patients sign the acknowledgment.

Accepted Answer

Acknowledgment of Receipt 
of Notice of Privacy Practices

Question 3

Authorization by a policyholder that allows a health plan to pay benefits directly to a provider.

Accepted Answer

assignment of benefits

Question 4

The guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary.

Accepted Answer

birthday rule

Question 5

Number returned electronically by a health plan approving a referral authorization request when preauthorization is required.

Accepted Answer

certification number

Question 6

Office procedures that ensure that billable services are recorded and reported for payment.

Accepted Answer

charge capture

Question 7

A unique number that identifies a patient.

Accepted Answer

chart number

Question 8

A clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim.

Accepted Answer

coordination of benefits (COB)

Question 9

Policy of collecting and retaining patients’ credit card information.

Accepted Answer

credit card on file (CCOF)

Question 10

Clinician who treats the patient face-to-face, in contrast to an indirect provider such as a laboratory.

Accepted Answer

direct provider

Question 11

Required payer response to the HIPAA standard transaction.

Accepted Answer

electronic eligibility verification

Question 12

A list of the diagnoses, procedures, and charges for a patient’s visit; also called the superbill.

Accepted Answer

encounter form

Question 13

Patient who has received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.

Accepted Answer

established patient (EP)

Question 14

A practice’s rules governing payment for medical services from patients.

Accepted Answer

financial policy

Question 15

Coordination of benefits rule for a child insured under both parents’ plans under which the father’s insurance is primary.

Accepted Answer

gender rule

Question 16

A person who is financially responsible for the bill from the practice.

Accepted Answer

guarantor

Question 17

The HIPAA ASCX12N 837 transaction that is sent to a secondary or tertiary payer on a claim with the primary payer’s remittance advice.

Accepted Answer

HIPAA Coordination of Benefits

Question 18

The HIPAA X12N 270/217 transaction in which a provider asks a health plan for information on a patient’s eligibility for benefits and receives an answer from the plan.

Accepted Answer

HIPAA Eligibility for a Health Plan

Question 19

The HIPAA X12N 278 transaction in which a provider asks a health plan for approval of a service and the health plan responds, providing a certification number for an approved request.

Accepted Answer

HIPAA Referral Certification 
and Authorization

Question 20

Clinician who does not interact face-to-face with the patient, such as a laboratory.

Accepted Answer

indirect provider

Question 21

The policyholder of a health plan or medical insurance policy; also known as guarantor.

Accepted Answer

insured or subscriber

Question 22

A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.

Accepted Answer

new patient (NP)

Question 23

A provider who chooses not to join a particular government or other health plan.

Accepted Answer

nonparticipating provider 
(nonPAR)

Question 24

An amount a medical practice may ask the patient to pay at the time of service that represents a percentage of the total estimated amount due for the current services received.

Accepted Answer

partial payment

Question 25

A provider who agrees to provide medical services to a payer’s policyholders according to the terms of the plan’s contract.

Accepted Answer

participating provider 
(PAR)

Question 26

Form that includes a patient’s personal, employment, and insurance company data needed to complete a healthcare claim; also known as a registration form.

Accepted Answer

patient information form

Question 27

Health plan that pays benefits first when a patient is covered by more than one plan.

Accepted Answer

primary insurance (payer)

Question 28

Identifying code assigned by a government program or health insurance plan when preauthorization is required; also called the certification number.

Accepted Answer

prior authorization number

Question 29

Electronic health insurance claim processed at patient check-out; allows practice to know what the patient will owe for the visit.

Accepted Answer

real-time adjudication (RCA)

Question 30

Authorization number given by a referring physician to the referred physician.

Accepted Answer

referral number

Question 31

Document a patient is asked to sign guaranteeing payment when a required referral authorization is pending.

Accepted Answer

referral waiver

Question 32

The physician who refers the patient to another physician for treatment.

Accepted Answer

referring physician

Question 33

The health plan that pays benefits after the primary plan pays when a patient is covered by more than one plan.

Accepted Answer

secondary insurance (payer)

Question 34

A patient who does not have insurance coverage.

Accepted Answer

self-pay patient

Question 35

Health plan, such as Medigap, that provides benefits for services that are not normally covered by a primary plan.

Accepted Answer

supplemental insurance

Question 36

The third payer on a claim.

Accepted Answer

tertiary insurance

Question 37

A number assigned to a HIPAA 270 electronic transaction sent to a health plan to inquire about patient eligibility for benefits.

Accepted Answer

trace number

MED112 CODE/BILL

MED112 CH 03 KEY TERMS

DEFINITION	TERM
MED112 CH 3 KEY TERMS
A participating physician’s agreement to accept the allowed charge as payment in full.	accept assignment (acceptance of assignment)
Form accompanying a covered entity’s Notice of Privacy Practices; covered entities must make a good-faith effort to have patients sign the acknowledgment.	Acknowledgment of Receipt of Notice of Privacy Practices
Authorization by a policyholder that allows a health plan to pay benefits directly to a provider.	assignment of benefits
The guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary.	birthday rule
Number returned electronically by a health plan approving a referral authorization request when preauthorization is required.	certification number
Office procedures that ensure that billable services are recorded and reported for payment.	charge capture
A unique number that identifies a patient.	chart number
A clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim.	coordination of benefits (COB)
Policy of collecting and retaining patients’ credit card information.	credit card on file (CCOF)
Clinician who treats the patient face-to-face, in contrast to an indirect provider such as a laboratory.	direct provider
Required payer response to the HIPAA standard transaction.	electronic eligibility verification
A list of the diagnoses, procedures, and charges for a patient’s visit; also called the superbill.	encounter form
Patient who has received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.	established patient (EP)
A practice’s rules governing payment for medical services from patients.	financial policy
Coordination of benefits rule for a child insured under both parents’ plans under which the father’s insurance is primary.	gender rule
A person who is financially responsible for the bill from the practice.	guarantor
The HIPAA ASCX12N 837 transaction that is sent to a secondary or tertiary payer on a claim with the primary payer’s remittance advice.	HIPAA Coordination of Benefits
The HIPAA X12N 270/217 transaction in which a provider asks a health plan for information on a patient’s eligibility for benefits and receives an answer from the plan.	HIPAA Eligibility for a Health Plan
The HIPAA X12N 278 transaction in which a provider asks a health plan for approval of a service and the health plan responds, providing a certification number for an approved request.	HIPAA Referral Certification and Authorization
Clinician who does not interact face-to-face with the patient, such as a laboratory.	indirect provider
The policyholder of a health plan or medical insurance policy; also known as guarantor.	insured or subscriber
A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.	new patient (NP)
A provider who chooses not to join a particular government or other health plan.	nonparticipating provider (nonPAR)
An amount a medical practice may ask the patient to pay at the time of service that represents a percentage of the total estimated amount due for the current services received.	partial payment
A provider who agrees to provide medical services to a payer’s policyholders according to the terms of the plan’s contract.	participating provider (PAR)
Form that includes a patient’s personal, employment, and insurance company data needed to complete a healthcare claim; also known as a registration form.	patient information form
Health plan that pays benefits first when a patient is covered by more than one plan.	primary insurance (payer)
Identifying code assigned by a government program or health insurance plan when preauthorization is required; also called the certification number.	prior authorization number
Electronic health insurance claim processed at patient check-out; allows practice to know what the patient will owe for the visit.	real-time adjudication (RCA)
Authorization number given by a referring physician to the referred physician.	referral number
Document a patient is asked to sign guaranteeing payment when a required referral authorization is pending.	referral waiver
The physician who refers the patient to another physician for treatment.	referring physician
The health plan that pays benefits after the primary plan pays when a patient is covered by more than one plan.	secondary insurance (payer)
A patient who does not have insurance coverage.	self-pay patient
Health plan, such as Medigap, that provides benefits for services that are not normally covered by a primary plan.	supplemental insurance
The third payer on a claim.	tertiary insurance
A number assigned to a HIPAA 270 electronic transaction sent to a health plan to inquire about patient eligibility for benefits.	trace number

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