Terminology

Question 1

Revenue Cycle includes…

Answer 1

The administration and clinical functions contributing to capturing a charge and receiving payment for services.

Question 2

Aging Reports

Answer 2

Outstanding balances in each account

Question 3

Outstanding balances in each report

Answer 3

Aging Report

Question 4

Ancillary Services

Answer 4

Any service that supports the patient’s care, such as lab services

Question 5

Any service that supports the patient’s care, such as lab services

Answer 5

Ancillary Services

Question 6

Assignment

Answer 6

A legal agreement allowing the provider to receive payment from an insurance payer

Question 7

A legal agreement allowing the provider to receive payment from an insurance payer

Answer 7

Assignment

Question 8

Attending Physician

Answer 8

The doctor legally responsible for overseeing inpatient care

Question 9

The doctor legally responsible for overseeing inpatient care

Answer 9

Attending Physician

Question 10

Beneficiary/Subscriber/Dependent/Enrollee/Member/Participant

Answer 10

The person benefiting from the insurance coverage

Question 11

The person benefiting from insurance coverage (6)

Answer 11

Beneficiary/Subscriber/Dependent/Enrollee/Member/Participant

Question 12

Capitation

Answer 12

The fixed amount a provider receives

Question 13

The fixed amount the provider receives

Answer 13

Capitation

Question 14

Clean Claim

Answer 14

A claim submitted to a payer within the timely filing period that has current and accurate information

Question 15

A claim submitted to a payer within the timely filing period that has current and accurate information

Answer 15

Clean Claim

Question 16

Coinsurance

Answer 16

The percentage of a covered medical service the insured individual is responsible for paying

Question 17

The percentage of a covered medical service the insured individual is responsible for paying

Answer 17

Coinsurance

Question 18

Co-Payment

Answer 18

A fixed dollar amount the insured individual pays the day services are rendered

Question 19

A fixed dollar amount the insured individual pays the day services are rendered

Answer 19

Co-Payment

Question 20

Concurrent Care

Answer 20

More than 1 physician providing patient care at the same time

Question 21

More than 1 physician providing patient care at the same time

Answer 21

Concurrent Care

Question 22

Crossover Claim

Answer 22

A claim submitted from the primary payer to the secondary payer

Question 23

A claim submitted from the primary payer to the secondary payer

Answer 23

Crossover Claim

Question 24

Deductible

Answer 24

The dollar amount paid by the insured before medical claims are reimbursed to the provider

Question 25

A dollar amount paid by the insured before medical claims are reimbursed to the provider

Answer 25

Deductible

Question 26

Denial

Answer 26

A statement from an insurance payer that payment won’t be received

Question 27

A statement from an insurance payer that payment won’t be received

Answer 27

Denial

Question 28

Denial Codes

Answer 28

Detailed information explaining a rejection or denial, varies per payer

Question 29

Detailed information explaining a rejection or denial, varies per payer

Answer 29

Denial Codes

Question 30

Documentation

Answer 30

Detailed written facts of observations, diagnoses, services, and procedures related to the patient’s health

Question 31

Detailed written facts of observations, diagnoses, services, and procedures related to the patient’s health

Answer 31

Documentation

Question 32

DME

Answer 32

Durable Medical Equipment

Question 33

EDI

Answer 33

Electronic data exchange; computerized submission of health insurance information

Question 34

EIN

Answer 34

Employer identification number; IRS-issued ID number for tax purposes

Question 35

Encounter Form/Superbill

Answer 35

A document containing coding information for a date of service

Question 36

A document containing coding information for a date of service

Answer 36

Encounter Form/Superbill

Question 37

EOB

Answer 37

Explanation of Benefits

Question 38

Explanation of Benefits (EOB)

Answer 38

A detailed listing of payments or denials per service

Question 39

Fee Schedule

Answer 39

A list of service payments per CPT/HCPCS code

Question 40

A list of service payments per CPT/HCPCS code

Answer 40

Fee Schedule

Question 41

Follow-Up Days/Global Days/Global Period

Answer 41

The established time frame after a surgically related procedure in which a provider treats the patient without a fee

Question 42

The established time frame after a surgically related procedure in which a provider treats the patient without a fee

Answer 42

Follow-Up/Global Days/Global Period

Question 43

GPN

Answer 43

Group Provider Number

Question 44

HMO

Answer 44

Health Maintenance Organization

Question 45

Invalid Claim

Answer 45

A claim that’s missing necessary information

Question 46

A claim that’s missing necessary information

Answer 46

Invalid Claim

Question 47

Medical Necessity

Answer 47

Documented need for a service is insufficient

Question 48

Documented need for a service is insufficient

Answer 48

Medical Necessity

Question 49

Medical Record

Answer 49

Documentation of a patient’s health care

Question 50

Documentation of a patient’s health care

Answer 50

Medical Record

Question 51

NDC

Answer 51

National Drug Codes

Question 52

NPI

Answer 52

National Provider Identifier

Question 53

POS

Answer 53

Place of Service

Question 54

Place of Service (POS)

Answer 54

A numeric assignment signifying where the patient was treated

Question 55

Prior (Pre-) Authorization

Answer 55

Written permission to treat a patient; must receive before a patient’s visits

Question 56

Written permission to treat a patient; must receive before a patient’s visits

Answer 56

Prior (Pre-) Authorization

Question 57

Predetermination

Answer 57

Written request to verify benefits

Question 58

Written request to verify benefits

Answer 58

Predetermination

Question 59

PIN

Answer 59

Provider Identification Number

Question 60

ERA

Answer 60

Electronic Remittance Advice

Question 61

Electronic Remittance Advice (ERA)

Answer 61

A report sent to a provider reflecting changes made to the original claim

Question 62

Reimbursement

Answer 62

Payment for Services

Question 63

Payment for Services

Answer 63

Reimbursement

Question 64

3rd-Party Payer

Answer 64

A payer, other than the patient, who pays for medical services

Question 65

A payer, other than the patient, who pays for medical services

Answer 65

3rd-Party Payer

Question 66

Medicare

Answer 66

Federal health insurance program originally created for individuals 65 or older

Question 67

Federal health insurance program originally created for individuals 65 or older

Answer 67

Medicare

Question 68

Medicaid

Answer 68

Government insurance option for individuals with low income and limited resources

Question 69

Government insurance option for individuals with low income and limited resources

Answer 69

Medicaid

Question 70

NCD

Answer 70

National Coverage Determinations

Question 71

NCDs explain…

Answer 71

When services will be covered by Medicare

Question 72

What explains when services will be covered by Medicare?

Answer 72

National Coverage Determinations

Question 73

LCD

Answer 73

Local Coverage Determinations

Question 74

Local coverage determinations explain…

Answer 74

When a service is considered necessary.

Question 75

What explains when a service is considered necessary.

Answer 75

Local Coverage Determinations

Question 76

ABN

Answer 76

Advanced Beneficiary Notice

Question 77

Advanced Beneficiary Notice explains…

Answer 77

Why a service or procedure may be denied

Question 78

What explains why a service or procedure may be denied?

Answer 78

Advanced Beneficiary Notice

Question 79

PE

Answer 79

Physician Expense

Question 80

MP

Answer 80

Malpractice

Question 81

GPCI

Answer 81

Geographic Practice Cost Index

Question 82

CF

Answer 82

Conversion Factor