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Insurance Billing
Insurance Billing YCST Chapters One and Two Terms
| Question | Answer |
|---|---|
| What is a national professional organization for promoting the art and science of medical record management and improving the quality of comprehensive health information for the welfare of the public? | American Health Information Management Association - AHIMA |
| What is a national professional society of physicians? | American Medical Association - AMA |
| In a medical practice, what is the amount of actual cash generated and available for use by the medical practice? | Cash flow |
| Who is a practitioner who works for the consumer and helps patients organize, complete, file, and negotiate health insurance claims of all types to obtain maximum benefits? | Claims assistance professional - CAP |
| What are standards of conduct generally accepted as a moral guide for behavior by which an insurance specialist may determine the appropriateness of their conduct in relationship with patients, physicians, co-workers, government and insurance companies? | Ethics |
| What are customs, rules of conduct, courtesy, and manners of the medical profession? | Etiquette |
| Who is a practitioner who carries out claims completion, coding and billing responsibilities, and may or may not perform managerial and supervisory functions? | An insurance billing specialist, a medical billing specialist, a reimbursement specialist, or a senior billing specialist. |
| What is an online computer service run from a website where questions may be posted by subscribers? | List service |
| Who is an individual cross-trained to provide more than one function, often in more than one discipline? | Multiskilled health practitioner |
| What means "Let the master answer"? | Respondeat superior |
| What are incidents or practices that are inconsistent with accepted sound medical business or fiscal practices? | Abuse |
| What is an individuals formal, written permission to use or disclose his or her personal identifiable health information for purposes other than treatment, payment, or health care operations? | Authorization |
| What is a document signed by the patient that is needed for use and disclosure of PHI that is not included in any existing consent form agreement? | Authorization form |
| What is an independent organization that receives insurance claims from the physician's office, performs software edits, and redistributes the claims electronically to various insurance carriers? | Clearing house |
| What is any set of codes with their descriptions used to encode data elements? | Code set |
| What is a process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry? | Compliance |
| What is a management plan composed of policies and procedures to accomplish uniformity, consistency, and conformity in medical record keeping that fulfills official requirements? | Compliance plan |
| What is the state of treating privately or secretly, and not disclosing to other individuals or for public knowledge, the patient's conversations or medical records? | Confidentiality |
| What is verbal or written agreement that gives approval to some action, situation, or statement? | Consent |
| What is a document that is not required before physicians use or discloses protected health information for treatment, payment, or routine health care operations of the patient? | Consent form |
| What is an entity that transmits health information in electronic form in connection with a transaction covered by HIPAA? | Covered entity |
| What is the release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information? | Disclosure |
| What is an intentional misrepresentation of the facts to deceive or mislead another? | Fraud |
| What is any part of an individual's helath information including demographic information collected from the individual that is created or received by a covered entity? | Individually identifiable health information |
| What is information consisting of ordinary facts unrelated to the treatment of a patient? | Nonprivileged information |
| Under HIPAA, what is a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to PHI? | Notice of Privacy Practices |
| What is the condition of being secluded from the presence or view of others? | Privacy |
| What is data related to the treatment and progress of the patient that can be released only when authorization of the patient or guardian is obtained? | Privileged information |
| What is any data that identifies an individual and describes his or her health status, age, sex, ethnicity, or other demographic characteristics? | Protected health information - PHI |
| Who is a person who protects the computer and networking systems within the practice and implements protocols? | Security officer |
| Under HIPAA, what are regulations related to the security of electronic protected health information? | Security Rule |
| What is a rule, condition, or requirement? | Standard |
Created by:
dsljulian
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