CMS
Program that was established in 1965 for hospital and supplemental insurance?
What is Medicare
Federal law which was enacted in 1996 to protect patients privacy.
What is HIPAA (Health Insurance Portability and Accountability Act)?
ICN and DCN
What is an internal control numbers and document control numbers
What is Blue Cross products
Patient access services to patient financial services
What is RCM
Inpatient, outpatient, pharmacy services, and advantage plans
What is Medicare Part A, B, C, & D
Computerized health records
What is EMR (Electronic Medical Records)?
Form given by primary care physicians to see a specialist.
What is a referral
Follow Medicare guidelines
What is a supplement plan
Process used when a provider disagrees with a determination for healthcare services rendered for reimbursement
What is an Appeal?
Medicare Part B requires patients to be responsible for this out of pocket expense.
What is deductible and co-insurance?
This should be done when sending PHI (Protected Health Information) electronically.
What is Encrypted?
This does not guarantee payment
What is an authorization
Deductible and out of pocket expenses
What is patient liability
The process healthcare organizations use to manage financial operations related to billing and collecting
What is revenue cycle management
Patients are informed decisions about specific services or items Medicare may not cover.
What is an ABN (Advanced Beneficiary Notice)?
A malicious program or code used to have access, damage or disable computer systems.
What is Malware?
When the initial submission sent to the clearinghouse is not accepted
What is a rejection
Denial codes that are needed to transfer balance to a patient
What is PR-96 or PR-204 denial
The next steps used after submission of billing
What is claim status?
Used for identifying if a particular item or service is covered to meet medical necessity
What is an LCD (Local Coverage Determinations)
Criminals use this trick to gain personal or financial information through emails, calls, texts or websites.
What is Phishing?
Process used by insurance companies to decide which plan pays
What is a COB (coordination of benefits)
The difference between what a provider bills for services and what the carrier will pay based on terms written.
What is a Contractual Adjustment?
Federal regulation guidelines for a single date of service cannot exceed this.
What is MUE (Medically Unlikely Edits)?