Insurance Basis
This is the monthly amount paid to keep an insurance policy active.
What is a premium
This coding system is used to report diagnoses.
What is ICD-10-CM
This is a request submitted to an insurance company for payment.
What is a claim
Billing for a higher-level service than was actually performed.
What is upcoding?
Before assigning codes, this must support every diagnosis and procedure.
What is documentation?
This is the fixed amount a patient pays at the time of a medical visit.
What is a premium?
This coding system is used to report medical procedures and services
What is CPT
This type of claim contains complete and accurate information and can be processed without delay.
What is a clean claim
Separating procedures that should be billed together to increase reimbursement.
What is unbundling?
This law protects the privacy of patient health information.
What is HIPAA?
This is the amount a patient must pay before insurance begins paying for covered services.
What is a deductible?
This coding system is used for medical supplies, durable medical equipment, and ambulance services.
What is HCPCS Level II
This process confirms a patient's insurance coverage before treatment.
What is insurance verification?
Repeated billing mistakes without intent to deceive are called this.
What is abuse?
Insurance companies only pay for services that meet this requirement.
What is medical necessity?
This document explains what the insurance company paid and what the patient may owe.
What is an Explanation of Benefits (EOB)?
This type of code explains why the patient received medical care.
What is a diagnosis code?
This standard paper form is commonly used to submit physician claims.
What is the CMS-1500 form?
Intentional deception for financial gain through false billing is called this.
What is fraud?
This is the payment received from an insurance company for covered healthcare services.
What is reimbursement?
This person is legally responsible for paying the patient's medical bill.
Who is the guarantor
This type of code identifies what service or procedure was performed.
What is a procedure code?
This report explains payments made by an insurance company after a claim has been processed.
What is a Remittance Advice (RA)?
Following official coding rules and regulations is known as this.
What is coding compliance?
This two-character addition to a CPT code provides extra information about a procedure or service.
What is a modifier?