Lesson 1

Question 1

Health Insurance claim

Answer 1

Is the documentation submitted to a third-party payer or government program requesting reimbursement for health care services provided.

Question 2

Hold harmless clause

Answer 2

Patient is not responsible for paying what the Insurance plan denies.

Question 3

Health care provider

Answer 3

A physician or other health care practitioner

Question 4

Centers of Medicare and Medicaid services (cms)

Answer 4

Administrative agency within the federal department of health and human services (DHHS)

Question 5

Coding

Answer 5

The process of assigning ICD-10, icd-10-pcs, cpt, hcpcs level ll codes which contain alphanumeric and numeric characters.
To diagnoses, procedures and services.

Question 6

Icd-10-cm

Answer 6

Coding system used to report diseases, injuries and other reasons for inpatient and outpatient encounters. Such as an annual physical examination performed at a physicians office.

Question 7

Icd-10-pcs

Answer 7

Coding system used to report procedures and services on inpatient hospital claims.

Question 8

Hcpcs

Answer 8

Two levels.
Cpt- coding system published by the American medical association that is used to report procedure and services performed during outpatient and physician office encounters and professional services provided to inpatients.

Hcpcs level ll codes (national codes)- coding system published by CMS that is used to report procedures , services and supplies not classified in cpt

Question 9

Medical necessity

Answer 9

Involved linking every procedure or service code reported in the claim to a condition code that justifies the need to perform that procedure or service.

Question 10

Health insurance specialist (reimbursement specialist)

Answer 10

Review health related claims to match medical necessity to procedures or services performed before payment is made to the provider.

Question 11

Claims examiner

Answer 11

Employed by a third part layer reviews health related claims to determine whether the charges are reasonable and for medical necessity.

Question 12

Medical assistant

Answer 12

Is employed by a provider to perform administrative and clinical tests that keep the office or clinic running smooth.

Question 13

Health Information technicians

Answer 13

Manage patient health Info and medical records, administer computer Information systems, and code diagnoses and procedures for health care services provided to patients.

Question 14

EOB

Answer 14

Explanation of benefits

Which is a report detailing the results of processing a claim.

Question 15

Remittance advice (or remit)

Answer 15

A notice sent by the Insurance company that contains payment Information about a claim.

Question 16

Respondeat superior

Answer 16

Latin for let the master answer. The employer is liable for the actions and omissions of employees

Question 17

Diagnosis codes

Answer 17

Are alphanumeric codes that identify diseases, disorders, symptoms , Injuries and other reasons for patient encounters.

Question 18

Procedure codes

Answer 18

Are numeric codes that identify commonly accepted description of medical procedures, services and supplies.

Question 19

Health insurance claim

Answer 19

A physicians request for payment from an insurance company for covered services, procedures and supplies provided to the patient.
A claim also contains the patients diagnoses to justify the need for the services, procedures and supplies.

Question 20

Payer

Answer 20

A payer is the insurance company that provided healthcare coverage. Sometimes referred to as the “third party payer”

Question 21

Ambulatory

Answer 21

An ambulatory healthcare setting is where services are provided on an outpatient basis, without admission to a hospital or other facility.
A doctors office is an example.

Question 22

Healthcare provider

Answer 22

Means a person licensed, certified or otherwise authorized or permitted by law to administer healthcare and establish the patients diagnosis and treatment plan.

Question 23

Professional liability insurance

Answer 23

Also known as errors and omissions insurance. Which provides protection from liability from errors in performing services.

Question 24

AAPC

Answer 24

Founded to elevate standards of medical coding. Provided certification , education and recognition.

Question 25

AAMA

Answer 25

American association of medical assistants

Question 26

AHIMA

Answer 26

American health Information management association

Founded in 1928 to improve quality of medical records and advanced health information management

Question 27

AMBA

Answer 27

American medical billing association