Insurance
This is the abbreviation for health maintenance organization?
What is HMO.
Misusing codes on a claim, such as upcoding or unbundling codes, is an example of what?
What is Medicare fraud and abuse
This is the amount of a non-covered service, the deductible, or out-of-pocket requirements that is noted on the EOB.
What is Coinsurance?
This standard unique health identifier for health care providers is called what?
What is an NPI (National Provider Identifier)
This is the International Classification of Diseases 10th revision, clinical modification.
What is ICD-10-CM
Payment for provider services from an insurance company
What is Reimbursement
Healthcare Common Procedure Coding System is more commonly known as what?
What is HCPCS
Similar to an EOB, this document is provider by the payer (insurance company) to the provider.
What is Remittance Advice.
A claim form can be sent to an insurance company two ways. What are they?
What is manually (in the mail) and electronically (by computer).
This is a term for ensuring that claims are correctly coded before being sent to the insurance company, which reduces denials and increases payments to the practice.
What is Scrub
Exists when a patient is covered under more than one insurance plan.
What is Secondary Insurance
International Classification of Diseases 10th revision, clinical modification is better known as this
What is ICD-10-CM
This is an agreement between the participating providers and the insurance company in which the physician agrees to accept the Medicare approved amount as full payment for covered services.
What is Medicare Assignment?
This is a type of claim is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service in the EHR?
What is a Crossover Claim
A private or public third party company that serves as the middleman between physicians and billing groups for transmission and translations of electronic claims.
What is a Clearinghouse
What is the term used for an individual that pays the premiums for an insurance policy?
What is a Policyholder
This is a numerical listing of procedures performed in medical practice published by the American Medical Association.
What is CPT (Current Procedural Terminology)
Authorization for an insurance carrier to pay the physician directly is called this.
What is an Assignment of Benefits?
This is the name of the universal claim form used to submit outpatient charges.
What is CMS-1500.
An detailed receipt that lists the services a healthcare provider has provided to a patient. It includes the charges and procedure codes for services rendered on that day.
What is a superbill?
This is the year that providers were able to start sending claims electronically to receive reimbursement.
What is 2005.
This is a coding marker that informs a 3rd party payer that circumstances for this particular code have been altered.
What is a Modifier.
If a provider submits claims electronically on this type of form, and has signed up to receive ERA and EFT, then payments will be submitted to the provider electronically.
What is the UB 04 Form
Whose Social Security number is used as the insurance plan ID number?
Who is the Policy Holder
What does HCPCS mean?
Healthcare Common Procedure Coding System.