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SYSTEM
PROVIDER
INSURANCE
MEDICAL BILLING
MISC
100

SPM stands for?

Specialty Practice Management

100
A doctor who is responsible for your general wellbeing.
PCP or Primary Care Physician
100
CMS stands for?
Centers for Medicare/Medicaid Services
100
What is a description to classify diseases, illnesses, and injuries in an alpha-numeric format?
DX or Diagnosis code
100

What is the maximum amount an insurance will consider to pay for a service, including any amount patient is responsible for paying?

Allowed Amount

200

PDS Stands for?

Professional Data Services

200
A doctor who has completed advanced education in a specific area of medicine?
Specialist
200
What is a joint federal and state program that helps with medical costs for some people with limited income and resources?
MEDICAID
200
What is a five digit code that is used to report medical , surgical, and diagnostic procedures / services to insurance companies and organizations?
CPT
200
What is the complete listing of fees used by insurance companies to pay doctors and other providers for a service?
Fee Schedule
300

What is the software that United Medical use as our database?

QuickBase

300
A term used for PCPs who send patients to a specialist for continuation of care.
Referring Doctor
300
What is a federal health insurance program for people who are 65 or older, younger people with disabilities, or individuals with end-stage renal disease?
Medicare.
300
What is a specified amount of money that the insured must pay before an insurance company will pay a claim?
Deductible
300
What is the law which protects the confidentiality and security of healthcare information?
HIPAA or Health Insurance Portability and Accountability Act
400
In the UM Billing Portal, which icon would you select to log in denial codes and time exceptions?
PRODUCTIVITY MANAGER
400
A unique identifying number used for tax purposes to identify payments received by the practice.
TIN or Tax Identification Number
400
What is the healthcare program of the United States Department of Defense Military Health System?
TRICARE
400
What is the amount the patient owes at the time of service?
COPAY
400
What is the type of insurance plan where the PCP has to be chosen, and patient usually needs referral to see a specialist?
HMO or Health Maintenance Organization
500
In which Portal can you view a Client's Information Profile?
UM Billing Portal
500
A 10 digit number that is a unique identification number for healthcare providers?
NPI or National Provider Identifier
500
What is a form of insurance providing medical benefits to employees injured in the course of employment?
Worker’s Compensation
500
What is a paper claim form sent to insurance companies detailing the services provided to patients; includes patient demographics, CPT codes (Current Procedural Terminology) and Dx (diagnosis) codes?
HCFA 1500 or claim 1500 form
500
What is the process of obtaining a contract with the insurance company in order to be paid for services provided to patients at a set rate?
Credentialing