Health Insurance Chapter 1
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| An insurance agreement that guarentees repayment for financial losses resulting from an employee's act or failure to act. Protects employers financial operations. | Bonding Insurance
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| The administrative agency within the federal department of health and human services. | Centers for Medicare and Medicaid Services
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| Published by the AMA and includes 5 digit numeric and alphanumeric codes and descriptions for procedures and services | Current Procedural Terminology (CPT)
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| Mutual exchange of data between the provider and insurance company | Electronic Data Interchange (EDI)
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| Provides protection from claims that contain errors and omissions resulting from professional services provided to clients (also called professional liability insurance) | Errors and Omissions Insurance
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| The principles of right and or good conduct | Ethics
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| A report detailing the results of processing a claim | Explanation of benefits
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| Published by CMS, and include 5 digit numeric and alphanumeric codes for procedures, services,and supplies not classified in CPT | HCPCS Level II Codes (aka-National Codes)
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| COnsists of two levels: Current Procedural Terminology, and National Codes (or HCPCS Level II codes) | Healthcare Common Procedure Coding System
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| The healthcare provider cannot collect the fees from the patient | Hold Harmless Clause
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| 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. | Independent Contractor
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| Linking every procedure or service code reported on the claim to an ICD-9 condition code t hat justifies the necessity for performing that procedure or service | Medical Necessity
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| Prior approval for treatment | Preauthorization
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| Protects business assets and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising | Professional Liability Insurance
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| A notice sent by the insurance company that contains payment information about a claim | Remittance Advice
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| The documentation submitted to the payer requesting reimbursement is called a... | Health Insurance Claim
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| The Centers for Medicare and Medicaid Services (CMS) was previously called the.... | Health Care Financing Administration
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| A health care practitioner is also calle a... | Provider
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| The mutual exchange of data between provider and payer is called... | Electronic Data Interchange
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| The process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters is called.... | Coding
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| If the health plan preauthorization requirements are not met by providers,.. | Payment of the Claim is denied
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| Which coding system is used to report diagnosis and conditions on claims? | ICD
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| The CPT coding system is published by the... | AMA
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| National codes are associated with... | HCPCS
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| Which report is sent to the patient to detail the results of claims processing? | Explanation of Benefits
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| A remittance advice contains... | Payment information about a claim
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| Which type of insurance guarantees repayment of financial loss resulting from an employee's act or failure to act? | Bonding
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| Medical malpractice insurance is a type of what insurance? | Liability
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| Which mandates workers' compensation insurance to cover employees and their dependenat against injury and death occurring during the course of employment? | State
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| The American Medical Billing Association offers which certification exam? | CMRS
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| The concept that every procedure or service reported to a third-party payer must be linked to a condition that justifies that procedure or service is called? | Medical Necessity
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| The administrative agency responsible for establishing rules for Medicare claims processing is called the..... | Centers for Medicare and Medicaid Services
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| Documentation submitted to an insurance company requesting reimbursement for health care services provided is called a.... | Health Insurance Claim
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| Which organization is responsible for administering the Certified Healthcare Reimbursement Specialist certification exam? | AMBA
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| Which clause is implemented if the requirements associated with preauthorization of a claim prior to payment are not met? | Hold Harmless Clause
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| Data published in the Occupational Outlook Handbook indicates the job opportunities for health insurance specialists will increase by what percentage? | 9-17 percent
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| The exchange of information between provider and third-party payer, using a standardized machine-readable format, is called.... | Electronic Data Interchange
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| The process of reporting diagnoses, procedures and services as numeric and alphanumeric characters on an insurance claim is.... | Coding
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| Which is another title for the health insurance specialist? | Claims Examiner
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| Which type of insurance should be purchased by health insurance specialist independent contractors? | Medical Malpractice
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| A health insurance specialist who is able to demonstrate cometency in facilitating the claims reimbursement process from the time a service is rendered by a provider until the balance is paid can qualify for which certification? | Certified Medical Reimbursement Specialist (CMRS)
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| Which certification fulfills the need for an entry-level coding credential? | Certified Coding Assistant (CCA)
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