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MEDICAL BILLING
Medical Billing II
TERMS 1
TERMS 2
TERMS 3
100
The agreement between health care practitioners and insurance carriers to allow payment for patient visits. It includes things like time delay allowed between billing and getting paid, and the information required to file a valid claim.
What is a managed care contract.
100
What are the ICD9 Book (book of diseases), CPT and National Code books, Computer skills, Internet skills, medical terminology (including anatomy & physiology)
What are required skills and knowledge for a medical biller.
100
What policy protects against financial loss due to employee mistakes or fraud?
What is bonding insurance
100
to steal from within a company
What is embezzling
100
a position that manages the health record systems of an organization and the quality of the information they contain
What is a health information technician
200
Two examples of state or federally funded health insurance usually for the elderly, disabled or indigent people who have no means of getting medical care. Usually pays (reimburses doctors) for about half what private insurance pays.
What are Medi-Cal and Medicaid
200
Communication, critical thinking, data entry, internet skills, and specific job vernacular (language)?
What are general skills for all careers
200
process of reporting diagnoses, procedures as numbers and letters on the insurance claim
What is coding
200
Provides protection from claims resulting from errors & omissions associated with professional services, as you are expected to do in your jobs.
What is errors & omission/liability insurance
200
Documentation submitted to insurance company when medical problems occur for payment for health care services
What is a health insurance claim
300
Federal law that states ALL patient information MUST remain private and that patients should have easy access to their own records. Made individuals liable for violations.
What is HIPAA
300
Making yourself understood and successfully understanding others (requires patience and insight into non-verbal communication, not just speaking) is good what?
What is communication
300
five digit numeric codes for procedures & services performed by providers
What are CPT codes
300
moral principles that govern a person's or group's behavior
What are ehtics
300
Someone who reviews health related claims to decide what is a medical need and what is just a want before payment is made to doctors
What is a health insurance/reimbursement specialist
400
Study of the location of body parts in an organism
What is anatomy
400
Being able to see the small differences between similar things, and taking appropriate action (recognizing danger, mistakes, lies, or simple differences) is what? Latin for "let the master answer", which means that the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment
What is critical thinking? What is respondeat superior
400
providers who send digital information to insurance companies in any form Defines the profession, qualifications, responsibilities and clarifies supervision requirements for health insurance specialists
What is electronic claims processing What is scope of practice
400
A report after filing a claim that explains what is covered by the insurance and what the patient (insured) has to pay themselves. Protection mandated by State law that covers employees and dependents against injury and death occurring during the course of employment
What is an Explanation of Benefits (EOB) What is Workers' Compensation Insurance
400
Patients cannot be held responsible for bills that their insurance refused to pay a person who performs specific services under an agreement without being under the control of those who pay them, and whose behavior the payers are NOT responsible for
What is a hold harmless clause What is an Independent contractor
500
Study of the function of the body parts and systems of an organism (how it all works). A notice sent by your insurance company that contains payment information & claim
What is physiology What is a remit, or remittance advice
500
What do we call the language of medicine? Prior approval from insurance required as well a follow up report after visit (treatment) BEFORE any payment will be made
What is medical terminology What is a preauthorization
500
mutual exchange of data between provider and insurance companies specific codes for procedures, services & supplies not classified (covered) under CPT codes
What is EDI (electronic data interchange) What are national codes Level II
500
A doctor or other licensed health care practitioner Protects business contents against fire, theft and other risks
What is a health care provider What is property insurance
500
Insurance that covers doctors and other health practitioners from lawsuits (claims) regarding their treatment of a patient in medical billing it involves linking every health care service with a code that justifies performing that service (pre determined needs by insurance company)
What is Medical Malpractice Insurance What is medical necessity