NHA CBCS Certification Study Guide with Complete Solutions

abstracting - ANSWER-the extraction of specific data from a medical record, often for use in an external database, such as a cancer registry abuse - ANSWER-practices that directly or indirectly result in unnecessary costs to the Medicare program account number - ANSWER-number that identifies specific episode of care, date of service, or patient accounts receivable department - ANSWER-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. activity/status date - ANSWER-Indicates the most recent activity of an item. actual charge - ANSWER-the amount the provider charges for the health care service Administration Simplification Compliance Act (ASCA) - ANSWER-specifically prohibits any payment by Medicare for services or medically necessary supplies that are not submitted electronically administrative services only (ASO) contract - ANSWER-Contract between employers and private insurers under which employers fund the plans themselves, and the private insurers administer the plans for the employers. Advance Beneficiary Notice of Noncoverage (ABN) - ANSWER-Form provided if a provider believes that a service may be declined because Medicare might consider it unnecessary. aging report - ANSWER-Measures the outstanding balances in each account. allowable charge - ANSWER-The amount an insurer will accept as full payment, minus applicable cost sharing. APC grouper - ANSWER-Helps coders determine the appropriate ambulatory payment classification (APC) for an outpatient encounter. assignment of benefits - ANSWER-Contract in which the provider directly bills the payer and accepts the allowable charge. auditing - ANSWER-review of claims for accuracy and completeness