Chapter 30 WORDS TO KNOW
QUESTIONS AND ANSWERS
1. Administrative Simplification Compliance (ASCA) - ANS-identifies limited situation
where paper claims forms may be submitted for payment( rather than electric
submission)signed into law on 12/27/2001
2. Carrier - ANS-one who carrier, transport with insurance it's a company that
providers the policy.
3. Center for Medicare and Medicaid Services (CMS) - ANS-previously known as the
Health Care Financing Administration (HCFA), is a federal agency within the
United States Department of Health and Human Services (HHS) that administers
the Medicare program and works in partnership with state governments to
administer Medicaid, the State Children's Health Insurance Program (SCHIP), and
health insurance portability standards
4. clearinghouse - ANS-a service company that receives electronic or paper claims
from the provider, checks and prepares them for processing, and transmits them
in HIPAA-complaint format to the correct carriers
5. CMS-1500 - ANS-Standard claim form used designed by the Center for Medicare
and Medicaid Services to submit physician services for third-party(insurance
companies) payments the standard paper forms to bill Medicare Fee-for-Services
Contractors when a paper claim is allowed
6. Electronic Claim Tracking (ECT) - ANS-computer software designated for monitoring
insurance claims
7. Electronic Data Interchange (EDI) - ANS-refers to the exchange of routine business
transaction from one computer to another in a standard format using standard
communication protocols
8. Electronic Media interchange - ANS-a flat file format used to transmit or transport
claims
9. Explanation of Benefits (EOB) - ANS-a printed description of the benefits provided
by the insurer to the beneficiary, provides information to the patient about how an
insurance claim from a health provider(such as a physician or hospital) was paid
on his or her behalf
10. National Provider Identifier (NPI) - ANS-The name of the standard unique health
identifier for health care providers.
11. Reimbursement - ANS-to pay back or compensate for money spent, or losses or
damage incurred payment for provider services (from insurance company)
12. scrub - ANS-claim scrubbing ensures that claims are correctly coded before being
sent to the insurance company, which reduces denials and increases payments to
the practice.
QUESTIONS AND ANSWERS
1. Administrative Simplification Compliance (ASCA) - ANS-identifies limited situation
where paper claims forms may be submitted for payment( rather than electric
submission)signed into law on 12/27/2001
2. Carrier - ANS-one who carrier, transport with insurance it's a company that
providers the policy.
3. Center for Medicare and Medicaid Services (CMS) - ANS-previously known as the
Health Care Financing Administration (HCFA), is a federal agency within the
United States Department of Health and Human Services (HHS) that administers
the Medicare program and works in partnership with state governments to
administer Medicaid, the State Children's Health Insurance Program (SCHIP), and
health insurance portability standards
4. clearinghouse - ANS-a service company that receives electronic or paper claims
from the provider, checks and prepares them for processing, and transmits them
in HIPAA-complaint format to the correct carriers
5. CMS-1500 - ANS-Standard claim form used designed by the Center for Medicare
and Medicaid Services to submit physician services for third-party(insurance
companies) payments the standard paper forms to bill Medicare Fee-for-Services
Contractors when a paper claim is allowed
6. Electronic Claim Tracking (ECT) - ANS-computer software designated for monitoring
insurance claims
7. Electronic Data Interchange (EDI) - ANS-refers to the exchange of routine business
transaction from one computer to another in a standard format using standard
communication protocols
8. Electronic Media interchange - ANS-a flat file format used to transmit or transport
claims
9. Explanation of Benefits (EOB) - ANS-a printed description of the benefits provided
by the insurer to the beneficiary, provides information to the patient about how an
insurance claim from a health provider(such as a physician or hospital) was paid
on his or her behalf
10. National Provider Identifier (NPI) - ANS-The name of the standard unique health
identifier for health care providers.
11. Reimbursement - ANS-to pay back or compensate for money spent, or losses or
damage incurred payment for provider services (from insurance company)
12. scrub - ANS-claim scrubbing ensures that claims are correctly coded before being
sent to the insurance company, which reduces denials and increases payments to
the practice.
