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Quiz: abstracting Ans: The extraction of specific data from a medical record,
often for use in an external database, such as a cancer registry.
Quiz: abuse Ans: practices that directly or indirectly result in unnecessary
costs to the Medicare program
Quiz: account number Ans: Number that identifies specific episode of care,
date of service, or patient.
Quiz: accounts receivable department Ans: Department that keeps track of
what third-party payers the provider is waiting to hear from and what patients
are due to make a payment.
Quiz: activity/status date Ans: Indicates the most recent activity of an item.
Quiz: actual charge Ans: The amount the provider charges for the health
care service.
Quiz: Administration Simplification Compliance Act Ans: specifically
prohibits any payment by Medicare for services or medically necessary
supplies that are not submitted electronically
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,Quiz: administrative services only contract Ans: Contract between
employers and private insurers under which employers fund the plans
themselves, and the private insurance administers the plans for employees.
Quiz: balance billing Ans: Billing patients for charges in excess of the
Medicare fee schedule.
Quiz: batch Ans: a group of submitted claims
Quiz: Blue Cross and Blue Shield plan Ans: The first prepaid plan in the U.S.
that offers health insurance to individuals, small businesses, seniors, and large
employer groups.
Quiz: business associate Ans: Individuals, groups, or organizations, who are
not members of a covered entity's workforce, that perform functions or
activities on behalf of or for a covered entity.
Quiz: Advance Beneficiary Notice of Noncoverage (ABN) Ans: Form
provided if a provider believes that a service may be declined because
Medicare might consider it unnecessary.
Quiz: aging report Ans: Measures the outstanding balances in each account.
Quiz: allowable charge Ans: The amount an insurer will accept as full
payment, minus applicable cost sharing.
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, Quiz: APC grouper Ans: Helps coders determine the appropriate
ambulatory payment classification (APC) for an outpatient encounter.
Quiz: assignment of benefits Ans: Contract in which the provider directly
bills the payer and accepts the allowable charge.
Quiz: auditing Ans: Review of claims for accuracy and completeness.
Quiz: authorization Ans: Permission granted by the patient or the patient's
representative to release information for reasons other than treatment,
payment, or health care operations.
Quiz: capitation Ans: The fixed amount a provider receives.
Quiz: case management Ans: a review of clinical services being performed
Quiz: category I cpt code Ans: Code that covers physicians' services and
hospital outpatient coding.
Quiz: category II cpt code Ans: Code designed to serve as supplemental
tracking codes that can be used for performance measurement.
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