Chapter 1

Question 1

Hold Harmless clause

Answer 1

patient is not responsible for paying what the insurance plan denies

Question 2

Old name of Centers for Medicare and Medicaid Services?

Answer 2

Health Care Financing Administration

Question 3

Health insurance specialist

Answer 3

review health related claims to determine the medical necessity for procedures or services performed before payment is made tot he provider

Question 4

Electronic claims processing

Answer 4

send data in a standardized machine readable format to an insurance company via disk, telephone modem, or cable

Question 5

Electronic data interchange EDI

Answer 5

mutual exchange of data between the provider and insurance company

Question 6

coding

Answer 6

the process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the insurance claim

Question 7

What systems are used for coding

Answer 7

ICD-9 CM and HCPGS

Question 8

ICD-9 CM

Answer 8

international classification of diseases 9 edition clinical modification. Include a decimal point

Question 9

HCPGS

Answer 9

healthcare common procedure coding system

CPT or level 2 codes

Question 10

CPT

Answer 10

part of HCPGS. Current procedural terminology. 5 digit numeric and alphanumeric codes. Published by American Medical Association

Question 11

Level 2

Answer 11

part of HCPGS. other codes not classified in CPT

Question 12

Explanation of benefits

Answer 12

received y a patient. a report detailing the results of processing a claim

Question 13

remittance advice

Answer 13

received by a provider. a notice sent by the insurance company that contains payment information about a claim

Question 14

professional liability insurance

Answer 14

provides protection from claims that contain errors and omissions resulting from professional services provided to clients as expected of a person in the contractors profession

Question 15

bonding insurance

Answer 15

insurance agreement that guarantees repayment for financial losses resulting from an employees act of failure to act

Question 16

liability insurance

Answer 16

protects business assets and covers the cost of lawsuit resulting rom bodily injury, personal injury, and false advertising.Ex. Medical malpractice

Question 17

Property insurance

Answer 17

protects business contents agains fire, theft and other risks

Question 18

workers compensation insurance

Answer 18

protection mandated by state law that ovcers employees and their dependents against injury and death occurring during the course of employment. not health insurance. purpose is to provide financial and medical benefits to those wit work related injuries, and their families, regardless of fault

Question 19

Respondeat superior

Answer 19

a health care facility or physician is legally responsible for employees actions performed within the context of their employment