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Health Insurance

HI chp 1

QuestionAnswer
What is prior approval for treatment by specialists called? Preauthorization
What is a physician or other healthcare practitioner? Healthcare provider
What does the acronym CMS mean? Centers for Medicare and Medicaid Services
What involves linking every procedure or service code reported on a claim to an ICD-9-CM condition code that justifies the necessity for performing that procedure or service? Medical necessity
What does the acronym ICD-9-CM mean? International Classification of Diseases, 9th Revision, Clinical Modification
What does the acronym CPT mean? Current Procedural Terminology
What coding system that is published by the CMS is used to report procedures, services, and supplies not classified in CPT? HCPCS
What does the acronym HCPCS mean? Healthcare Common Procedure Coding System
What are principles of right or good conduct and rules that govern the conduct of members of a profession? Ethics
What does the acronym EOB mean? Explanation of Benefits
What report details the results of processing a claim? EOB
What does the provider receive from the insurance company that contains payment information about a claim? Remittance Advice
What defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements? Scope of Practice
Who performs services for another under an express or implied agreement and who is not subject ot the others' control, or right to control, of the manner and means of prforming services? Independent contractor
What is another name for professional liability insurance? Errors and Omissions Insurance
What provides protection from claims that contain errors and omissions resulting from professional services proviced to clients as expected of a person in the contractor's profession? Professional Liability Insurance
What is a computer-to-computer exchange of data between provider and payer? EDI
What does the acronym EDI mean? Electronic Data Interchange
What coding system is used to report diagnoses and reasons for encounters? ICD-9-CM
What coding system is used to report procedures and services in physician's offices? CPT
Created by: YTIMBC
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