Flashcard Set Preview
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Alliance and Claims Assistance Professionals
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ACAPprofessional association that represents professionals dedicated to the effective management...
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American Academy of Professional Coders
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AAPCprofessional association established to provide a national certification and credentialing...
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American Health Information Management Association
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AHIMAprofessional association that represents more than 40,000 health information management...
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Centers for Medicare and Medicaid Services
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CMSformerly knows as the Health Care Financing Administration (HCFA), it is an administrative...
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coding
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process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters...
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Current Procedural Terminology
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published by the American Medical Association and includes five-digit numeric codes and descriptors...
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electronic claims processing
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sending data in a standardized machine-readable format to an insurance company via disk, telephone,...
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electronic data interchange
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mutual exchange of data between provider and payer
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ethics
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principle of right or good conduct; rules that govern the conduct of members of a profession
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explanation of benefits
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report that details the results of processing a claim
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health care provider
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physician or other health care practitioner
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Healthcare Common Procedure Coding System
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HCPCScoding system that consists of CPT, national codes (level II), and local codes (level...
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health insurance claim
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documentation submitted to an insurance plan requesting reimbursement for health care services...
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hold harmless clause
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patient is not responsible for paying what the insurance plan denies
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International Classification of Diseases, 9th Revision, Clinical Modification
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ICD-9-CMcoding system used to report diagnoses (e.g., diseases, signs, and symptoms) and reasons...
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local codes
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(level III codes)developed by local insurance companies and include five-digit alphanumeric...
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medical necessity
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involves linking every procedure or service reported to the insurance company to a condition...
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national codes
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(level II codes)commonly referred to as HCPCS codes, which include five-digit alphanumeric...
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preauthorization
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prior approval
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