Medical Billing Vocabulary Review Flashcards

Terms Definitions
a) demonstrates dedication, skill, and achievement
b) makes a biller a step above those not certified
c) designates a biller as a professional
d) can be a deciding factor in getting a job
e) all of the above
Who offers CHRS certification?
Current Procedure Terminology
Physician-based billing refers to:
a) durable medical equipment billing
b) hospital room charges
c) charges for a physician's services
d) all of the above
e) a and c
Health insurance cosponsored by federal and state governments for people of low income status.
CHRS is offered by:
a) American Medical Billing Association
b) National Electronic Billers Alliance
c) National Healthcare Association
Insurance for veterans with permanent service-related disabilities and their dependents. It also covers surviving spouses and dependent children of veterans who died from service-related disabilities.
A service bureau that collects electronic insurance claims, and forwards them to the appropriate insurance carrier. (WEBMd formerly NEIC)
continuing education unit
What does CEU stand for?
a level of measurement of noncredited education
a professional status or level earned by successful completion of an examination
An individual who has contracted with an insurance company for coverage. Also known as the insured.
Insurance Carrier
A company that provides insurance coverage to individuals and/or groups.
Workers' Compensation
People with job-related illnesses or injuries are covered under workers' compensation insurance. The benefits vary according to state law.
Which looks like how a payment should be entered on a CMS-1500 form?
a) $25.00
b) 25.00
c) $25 00
d) 25 00
Certified in Healthcare Privacy
What does CHP stand for?
National Electronic Billers Alliance
What does NEBA stand for?
ABN-Advanced Beneficiary Notice
A statement specifically used by Medicare advising the patient that the procedure you wish to do may or may not be covered by Medicare. It is specific to time, date and particular service, it cannot be a general statement.
Day Sheet
A report that lists all transactions for a single day. This report is pulled at the end of each office session. It must be balanced according to all charges and payments. To balance out a day, transactions listed on superbills (charges and payments) and totals from deposit tickets are compared against the computer-generated day sheet.
Aging Reports
A report which lists the outstanding balances owed to the practice by insurance companies or patients. This report can be used to perform cycle billing and insurance follow-up.
Global Care
A surgical "package" including the 24 hour period before surgery, the surgery day and a period of time after for billing purposes related to that surgery.
Coordination of Benefits -(COB)
Consolidates all insurance coverage, identifies all health benefits and allows them to pay correctly.
medical billing company
an offsite company hired to process medical bills for the physician
CCI-Current Coding Initiative
A listing of procedures that are "bundled" into one, items that are considerd an integral part of each other and therefore cannot be billed separately.
Managed Care
A type of insurance in which the insurance carrier is responsible for the financing and the delivery of healthcare.
A type of insurance plan in which the patient is responsible for a percentage of the charges.
accounts receivable
monies owed to a physician for his or her services
CF-Conversion Factor
The value to multiply with the RVU to reach a dollar amount allowance for the fee schedule.
Schedule of Benefits
In an insurance policy, a listing of services covered and the amount of coverage.
OIG-Office of the Inspector General
Guidelines for Fraud and Abuse including th "Work Plan", items the US Government are looking into carefully for illegal billing practices.
Electronic Remittance Advice (ERA)/Explanation of Benefits (EOB)
A document from an insurance carrier that lists the amount of a benefit and explains how it was determined.
UPIN-Unique Physician Identifying Number
The number issued to a physician for billing purposes, a required number on all consultations, not to be confused with the physician's individual Identification Number issued by Medicare.
RVU- Relative Value Unit
The value placed on each procedure to use with the conversion factor to reach the Medicare Fee allowance.
HCFA 1500, Health Insurance Claim Form
A universal health insurance claim form used by governmental health programs and many private insurance carriers.
HMO or Health Maintenance Organization
A type of managed care system in which patients pay fixed rates at regular intervals. In HMO's, patients must choose from a specific group of physicians and hospitals for their medical care.
PPO or Preferred Provider Organization
A type of managed care system in which patients pay fixed rates at regular intervals. A PPO is a network of health care providers who agree to perform services for plan members at discounted fees. Members may receive care from providers outside the network for a higher cost.
You enter both without hyphens or spaces
T or F: On CMS-1500 forms, you enter Social Security and employee identification numbers with spaces rather than hyphens
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