Medical Billing Flashcards

Terms Definitions
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Who offers CHP certification?
Who offers CBCS certification?
International Clasification of Diseases
pertaining only to a physician
Services performed by a provider.
_________ claims require entry of active duty sponsor rank/grade after the name.
Patient Data
Personal information about the patient, as well as information on the patient's insurance coverage, is extracted from the programs patient database.
A government program that covers medical expenses for dependents of active duty members of the uniformed services and for retired military personnel. Formerly known as CHAMPUS, it also covers dependents of military personnel who are killed while on active duty.
National Helathcareer Association
What does NHA stand for?
Claims Assistance Professional
What does CAP stand for?
How should you enter a telephone number on a CMS-1500 form?
a) (123) 456-7890
b) 123-456-7890
c) 123 456 7890
d) (123) 456 7890
e) 1234567890
Walkout Receipt
A document listing charges and payments that is given to a patient after an office visit. This document can also be sent into an insurance company for payment.
A form listing procedures relevant to the specialty of a medical office, used to indicate what procedures were performed.
A physician's opinion of the nature of an illness or injury. Listed in the ICD-9-CM ("D" for diagnosis or why you did it).
Transaction Data
Transaction information is taken from the superbill and keyed into the computer program. It included the date of the visit, diagnosis and procedure codes, lab work and payments made.
If a medical biller does not file accurate claims, it could result in:
a) physician not getting paid
b) physician will not be able to meet office expenses
c) physician may not be able to afford malpractice insurance
d) other employees of physician may not get paid
e) a physician could get audited
f) a physican could suffer legal consequences
g) all of the above
Certified Healthcare Reimbursement Specialist
What does CHRS stand for?
Certified Medical Reimbursement Specialist
What does CMRS stand for?
Indemnity Plan
An insurance plan in which the policyholders are reimbursed for healthcare costs. Under the indemnity paln the schedule of benefits in the policy lists the services that are covered and the amounts that are paid. The benefit may be for all or part of the charges. For example, the schedule of benefits may indicate the 80% of charges for surgery performed in hospital are covered. The policyholder is responsible for paying the 20%.
Accounting Cycle
The flow of financial transactions in a business, from making a sale to collecting payment for the goods or services delivered. In a medical practice, this is the cycle from seeing and treating the patient to receiving payments for the services provided.
Audit/Edit Report
A report from a clearinghouse that lists errors that need to be corrected before a claim can be submitted to the insurance carrier. This report needs to be examined and corrections made immediately to speed the processing and the payment of claims.
T or F: You should use Caps Lock because CMS-1500 form only accepts capital letters
Health Insurance Portability and Accountability Act
What does HIPAA stand for?
The patient's full name: William F. Goodpatient IV
It appears on his card:  William F. Goodpatient
How would you type the name?
American Health Information Management Association
What does AHIMA stand for?
Certified Billing and Coding Specialist
What does CBCS stand for?
Electronic Funds Transfer (EFT)
A system that transfers money electronically from one account to another.
Practice Analysis Report
A report generated by the computer which summarizes the financial activity of the entire month. This report lists charges, payments, and adjustments and the total accounts receivable for the month. It is possible to balance out the month by taking all the day sheets for the month, totaling the charges, payments, and adjustments, and then comparing the totals to the amounts listed on the practice analysis report.
Accounts Receivable (A/R)
Monies that are flowing into a business.
Registration Form or Patient Information Form
A document that contains personal, employment and medical insurance information about a patient.
Third Party Payer
A term used to describe an insurance carrier in the context of the physician's and the patient's relationship.
The name on the patient's ID card is William F. Goodpatient IV.  How do you write the name on a CMS-1500 form?
Electronic Media Claim (EMC)
An insurance claim that is sent by a computer over the telephone line using a modem.
A medical biller may also have this job function
T or F:  While a medical biller submits claims, an accountant is always responsible for maintaining the physician's accounts receivable
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