Practice Management Software - ANSWER Coordinates the business aspects of a practice
Narrow Networks - ANSWER When an insurer works with a small pool of in- network-pro-
viders
Durable Medical Equipment - ANSWER Devices and supplies like canes and walkers, port-
able oxygenation systems, and continence supplies
Patient Portal - ANSWER Secure, online, 24-hours access to personal health information
CPT Codes - ANSWER Used by outpatient and professional organizations
ICD-10-PCS Codes - ANSWER Used by inpatient hospitals
Patient Responsibility - ANSWER Deductible, coinsurance and copayment
HCPCS Codes - ANSWER A coding classification system in which level I (CPT Codes) are
used to bill outpatient procedures and physician services and level II (HCPCS codes) is used
to bill professional services, supplies, and products not included in CPT Codes.
Modifiers - ANSWER in the HCPCS code set are used when procedures and services need
to be clarified
Formal referral - ANSWER is an authorization request to determine medical necessity.
1
, Direct referral - ANSWER is an authorization request form that is completed and signed
by a provider and given directly to a patient.
Verbal referral - ANSWER is given when a provider informs a patient and request the re-
ferring service provider to set up a patient appointment
Self-referral - ANSWER occurs when patients refer themselves and make their own ar-
rangements to see the specialist.
Current Procedural Terminology, 4th Ed (CPT-4) - ANSWER A coding classification system
used to report professional services and procedures provided to a patient at ambulatory
care centers, medical clinics, and other outpatient care facilities.
Encoder - ANSWER Software used to assign diagnosis and procedure codes
Encounter Form - ANSWER An itemized bill for services that contains diagnosis and pro-
cedure codes and is used by administrative staff to complete claim forms; also known as a
superbill, fee slip, or charge form.
International Classification of Diseases, 10th Rev., Clinical Modification (ICD-10-CM) - AN-
SWER A diagnostic classification & coding system for diagnoses used by health care or-
ganizations.
International Classification of Diseases, 10 Rev., Procedure Coding System (ICD-10-PCS) inpa-
tient facilities. - ANSWER A classification system for procedures performed at inpatient
facilities.
Physician Query - ANSWER A request that a provider add documentation to the EHR to
clarify a diagnosis or procedure that has been performed.
2
Narrow Networks - ANSWER When an insurer works with a small pool of in- network-pro-
viders
Durable Medical Equipment - ANSWER Devices and supplies like canes and walkers, port-
able oxygenation systems, and continence supplies
Patient Portal - ANSWER Secure, online, 24-hours access to personal health information
CPT Codes - ANSWER Used by outpatient and professional organizations
ICD-10-PCS Codes - ANSWER Used by inpatient hospitals
Patient Responsibility - ANSWER Deductible, coinsurance and copayment
HCPCS Codes - ANSWER A coding classification system in which level I (CPT Codes) are
used to bill outpatient procedures and physician services and level II (HCPCS codes) is used
to bill professional services, supplies, and products not included in CPT Codes.
Modifiers - ANSWER in the HCPCS code set are used when procedures and services need
to be clarified
Formal referral - ANSWER is an authorization request to determine medical necessity.
1
, Direct referral - ANSWER is an authorization request form that is completed and signed
by a provider and given directly to a patient.
Verbal referral - ANSWER is given when a provider informs a patient and request the re-
ferring service provider to set up a patient appointment
Self-referral - ANSWER occurs when patients refer themselves and make their own ar-
rangements to see the specialist.
Current Procedural Terminology, 4th Ed (CPT-4) - ANSWER A coding classification system
used to report professional services and procedures provided to a patient at ambulatory
care centers, medical clinics, and other outpatient care facilities.
Encoder - ANSWER Software used to assign diagnosis and procedure codes
Encounter Form - ANSWER An itemized bill for services that contains diagnosis and pro-
cedure codes and is used by administrative staff to complete claim forms; also known as a
superbill, fee slip, or charge form.
International Classification of Diseases, 10th Rev., Clinical Modification (ICD-10-CM) - AN-
SWER A diagnostic classification & coding system for diagnoses used by health care or-
ganizations.
International Classification of Diseases, 10 Rev., Procedure Coding System (ICD-10-PCS) inpa-
tient facilities. - ANSWER A classification system for procedures performed at inpatient
facilities.
Physician Query - ANSWER A request that a provider add documentation to the EHR to
clarify a diagnosis or procedure that has been performed.
2
