A CPT code for an office visit is a representation of this.
What is a transaction?
100
A statement issued to the patient (insured) and the provider by the insurance company that explains the services provided, amount billed, and payments paid by insurance.
What is an Explanation of Benefits (EOB)?
100
This is an organizations process to improve documentation for reimbursement purposes.
What is clinical documentation improvement (CDI)?
100
This form is required to code before the bill can be dropped.
What is the discharge summary?
100
This statutory law standardize transaction standards and code sets.
What is the Health Insurance Portability Accountability Act (HIPAA)?
200
Something that is owned or due to be received is this.
What is an asset?
200
This type of reimbursement is when the provider is paid on an agreed upon amount for each defined unit of service.
What is fee-for-service?
200
The charge code, item description, general ledger key, revenue code and charge are parts of this form.
What is the chargemaster?
200
This software that analyzes healthcare documents and produces appropriate medical codes for specific phrases and terms within the document.
What is computer assisted coding (CAC) software?
200
This is the official billing form required for Medicare and Medicaid for reimbursement.
What is CMS1500?
300
DNFB stands for this.
What is Discharged, Not Final Bill?
300
This type of reimbursement is for Medicare Part B that is based on the providers location, practice costs and malpractice insurance rate.
What is resource based relative value scale (RBRVS)?
300
This occurs when multiple procedure codes are billed for a group of procedures that are covered by a single comprehensive code.
What is unbundling?
300
This term signifies a complete and accurate claim form that includes all provider and member information, as well as records, additional information, or documents needed from the member or provider to process the claim.
What is a clean claim?
300
Medicare contracts beneficiary and provider services, provider enrollment, reimbursement, appeals process and provider education to training to this group.
What are Medicare Administrative Contractors (MAC)?
400
This database is of all supplies and services provided to patients and corresponding charges for those items.
What is a charge description master?
400
This payment system covers outpatient procedures and same day medical services.
What is ambulatory payment classification (APCs)?
400
True or false, you can bill for an open order.
What is False?
400
This is a charge posted after the day of service.
What is a late charge?
400
These are written into software programs to ensure that claims comply with payer rules to ensure a clean claim before the bill is dropped.
What are edits? (software is a scrubber)
500
This type of cost can be managed by a department director.
What is controlled?
500
This financial government initiative was provided to providers as part of the Health Information Technology for Economical and Clinical Health (HITECH)Act for the implementation of the EHR.
What is Meaningful Use?
500
The Affordable Care Act initiated this reduction program where hospitals are not allowed to increase the DRG payment for this occurrence during the hospital stay?
What is hospital acquired condition (HAC)?
500
This relative value is assigned to a diagnosis-related group (DRG/MSDRG) of patients and the value is used in determining the allocation of resources to care for and/or treat the patients in the group.
What is case mix index (CMI)?
500
When a provider is failed to be paid it is written off as this.