The person responsible for the patient’s portion of the bill
What is a guarantor?
100
A fixed amount a health plan may require a patient to pay at each visit
What is a copay?
100
Explanation of benefits
What is remittance advice?
200
Standardized codes for reporting medical services, procedures, and treatments performed for patients by the medical staff
What are CPT-4 codes?
200
Software used to analyze claims for errors before submission
What is a claims scrubber?
200
The ORYX initiative was developed by this group
What is The Joint Commission?
200
The amount the provider receives from the insurance plan
What is the remittance?
200
Coordination of benefits claim
What is a piggyback claim?
300
This claim occurs when the primary insurance plan automatically sends a claim on to the secondary insurance plan
What is coordination of benefit?
300
Codes for billing supplies, injectable medications, and blood products
What are HCPCS II codes?
300
A person who is entitled to received benefits from a plan
What is the beneficiary?
300
A fixed minimum that the patient must pay before a plan begins paying
What is a deductible?
300
Two other names for encounter form
What is superbill and charge ticket?
400
This is the type of HMO model that succeeds when the group of patients is large enough that the costs of treating members who need services and those who never see the doctor average out
What is a capitation plan?
400
An ICD-9-CM code category that is used for non-illness conditions
What are "V" codes?
400
The Veteran’s Administration provides hospitals and healthcare services to these persons
What are military veterans?
400
Companies that contract with CMS programs to process claims and disburse payments
What are fiscal intermediaries?
400
UB-04
What is CMS-1450?
500
This intermediary performs the specific function of converting data arriving in a noncompliant format into a HIPAA-compliant format for electronic transmission
What is a clearinghouse?
500
The payment floor for electronic claims AND for paper claims
What is 14 days for electronic and 29 days for paper?
500
People under the age of 65 who have disabilities; people of any age with kidney failure requiring dialysis or transplant, and people 65 and older.
Who are entitled to receive Medicare?
500
Uncollected money owed during the billing process
What is accounts receivable?
500
Four names for the primary person on the health insurance card
What are subscriber, enrollee, beneficiary, member?