Coding and Billing Ch. 1

Question 1

AAPC

Answer 1

American Academy of Professional Coders, established to provide a national certification/credentialing process, to support national and local membership by providing educational products and opprotunities to networks, and to increase and promote national recognition for pro coding and billing.

Question 2

AAMA

Answer 2

American Association of Medical Assisstants. enables medical assissting professionals to enhance and demostrate the knowledge, skills, and professionallism required by employers and patients; as well as protect MA right to practice in theie field setting.

Question 3

AHIMA

Answer 3

American Health Information Management Association. Founded in 1928 to improve the quality of medical records, and currently advances the health information management (HIM) profession toward an electronic and global environment, including implementation of ICD-10-ICM and ICD-10-PCS in 2013

Question 4

bonding insurance

Answer 4

an insurance agreement that guarantess repayment for financial losses resulting from the act or failure to act of an employee. It protects the financial operations of employer.

Question 5

business liability insurance

Answer 5

protects business assests and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising..

Question 6

Centers for Medicare and Medicaid Services

Answer 6

CMS fromerly known as the Health Care Financing Administration HCFA; an administrative agency within the federal Department of Health and Human Resources (DHHS)

Question 7

claims examiner

Answer 7

employed by third-party payers to review health-related claims to determine whether the charges are resonable and medically necessary based on the patient’s diagnosis.

Question 8

coder coding

Answer 8

process of preorting diagnoses, procedures, services, and supplies as numeric and alphanumeric characters (called codes) on the insurance claim.

Question 9

embezzle

Answer 9

the illegal transfer of money or property as a fraudulent action; to steal money from an amployer.

Question 10

errors and omissions insurance

Answer 10

see professional libility inusrance. provides protection from liability as a result of errors and omissions when performing their professional services.

AKA: professional liability insurance

Question 11

ethics

Answer 11

principle of right or good conduct; rules that govern the conduct of members of a profession.

Question 12

health care provider

Answer 12

physican or other health care practioners (e.g physcians assisstant)

Question 13

health infomration technicians

Answer 13

professionals who manage patient health informatio and medical records, administer computer information systems, and code diagnoses and procedures for health care services provider to patients.

Question 14

health insurance claims

Answer 14

doumentation that is electronically or manually submitted to an insurance plan requesting reimbursement for health care procedures and services provided (e.g. CMS-1500 and UB-04 claims)

Question 15

health insurance specialist

Answer 15

person who reviews health-related claims to match medical necessity to procedures or services performed before payment (reimbursement) is made to the provider

AKA: reimbursment specialist

Question 16

hold harmless clause

Answer 16

policy that the patient is not responsible for paying what the insurance plan denies.

Question 17

independent contractor

Answer 17

defined by the ‘Lectric Law Library’s Lexicon as “a person who performs services for another under an express or implied agreement and who is not subject to the other’s control, or right to control, of the manner and means of performing the services. The orgz. that hires an independent contractor is not liable for the acts or omissions of the independent contractor.”

Question 18

internship

Answer 18

nonpaid professional practice expereince that benefits students and facilities that accept students for placment; students receive on-the-job expereince prior to graduation, and the internship assists them in obtaining permanent employment.

Question 19

medical assistant

Answer 19

employed by a provider to perform administritive and clinical tasks that keep the office or clinic running smoothly

Question 20

medical malpractice insurance

Answer 20

a type of liability insurance that covers physcians and other health care professionals for liability claims arising from patient treatment.

Question 21

medical necessity

Answer 21

involves linking every procedure or service code reported on an insurance claim to a condition code (e.g. disease, injury, sign, symptom, other reason for encounter) that justifies the need to perform that procedure or service.

Question 22

professional libility insurance

Answer 22

AKA: see errors and omissions insurance

Question 23

professionalism

Answer 23

conduct or qulaities that characrterize a professional person

Question 24

property insurance

Answer 24

protects business contents (e.g. buildings and equipment) against fire, theft, and other risks

Question 25

reimbursement specialists

Answer 25

AKA: see health insurance specialists

Question 26

respondeat superior

Answer 26

Latin for “let the master answer” legal doctrine holding that the employer is laible for the actions and omissions of employees performed and committed within the scope of their employment

Question 27

scope of practice

Answer 27

health care services, determined by the state, that an NP and PA can perform