CHAPTER 6, 7 TERMS

Question 1

ABUSE

Answer 1

Action that improperly uses another person’s resources

Question 2

Authorization

Answer 2

prior approval

Question 3

Adjustment

Answer 3

is a wright off of uncollectible

Question 4

allowed charge

Answer 4

charge the insurance company allows for payment of procedure or treatment

Question 5

Balance billiing

Answer 5

difference between a providers charge and payers lower allowed fee

Question 6

Code linage

Answer 6

linking a procedure code to the correct diagnosis

Question 7

External Audit

Answer 7

outside organization performs an audit

Question 8

Geographic practice cost index

Answer 8

Medicare factor used to adjust dr. fees based on location. (park aven, cost vs eastern long island

Question 9

Internal Audit

Answer 9

staff will do a staged audit so that the office will be aware how to keep errors down on claims and prevent live audits

Question 10

professional curtesy

Answer 10

when a dr. will charge less for a service for family or other co workers as a courtesy

Question 11

prospective audit

Answer 11

is a practice audit done before the bills are sent in for billing or transmitted

Question 12

retrospective audit

Answer 12

an internal audit done after bills are sent to the billing department

Question 13

claim attachment

Answer 13

documentation that a provider sends to a payer in support of a healthcare claim

Question 14

claim scrubber

Answer 14

clearinghouse

Question 15

cms 1500 paper claim for a physician

Answer 15

paper claim for a physician

Question 16

NATIONAL UNIFORM CLAIM COMMITTEE

Answer 16

Organization responsible for the content of healthcare claims.

Question 17

POS

Answer 17

Place of service is the facility where the treatment was done

Question 18

rendering provider

Answer 18

provider treating the patient

Question 19

outside lab

Answer 19

lab outside of the drs office

Question 20

responsble party