NHA CBCS Certification Study Guide
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
authorization - Answer -Permission granted by the patient or the patient's representative to release
information for reasons other than treatment, payment, or health care operations.
balance billing - Answer -Billing patients for charges in excess of the Medicare fee schedule.
batch - Answer -a group of submitted claims
Blue Cross and Blue Shield plan - Answer -The first prepaid plan in the U.S. that offers health insurance
to individuals, small businesses, seniors, and large employer groups.
business associate (BA) - Answer -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.
capitation - Answer -the fixed amount a provider receives
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
authorization - Answer -Permission granted by the patient or the patient's representative to release
information for reasons other than treatment, payment, or health care operations.
balance billing - Answer -Billing patients for charges in excess of the Medicare fee schedule.
batch - Answer -a group of submitted claims
Blue Cross and Blue Shield plan - Answer -The first prepaid plan in the U.S. that offers health insurance
to individuals, small businesses, seniors, and large employer groups.
business associate (BA) - Answer -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.
capitation - Answer -the fixed amount a provider receives
