In the physicians office an encounter form is also called a

__________ is the process of reporting diagnoses, procedure, and services as numeric and alphanumeric characters on the insurance claim form.

Diagnosis codes use _______ coding system.

CPT stands for __________ _________ _________

Current Procedural Terminology

The two digit code attached to a main code to indicate that the procedure or service has been altered is called a __________.

Each procedure or service on the claim form must be linked to a condition that justifies the ________ _________ of performing the procedure or service. It will determine if a procedure or service will be reimbursed by a payer.

When a service or procedure does not match up with an appropriate diagnosis on a claim the procedure is determined to be ___________ __________.

A company that establishes a utilization management program and performs external utilization review services is a _________ _______________.

A managed care clause that prohibits providers from discussing all treatment options with patients is known as __________.

A physician or care facility under contract with a manage care plan is known as a _________ __________.

Any information communicated by a patient to a health care provider is considered __________.

The right of individuals to keep their protected health information from being disclosed to others is called __________.

The process of safekeeping patient information is known as _________.

If a health care professional releases confidential information to a person who has no demonstrable legal need to receive this information is called ____________ ____ ___________.

breach of confidentiality

When processing insurance claims, health care professionals must ensure that the patient signed the "___________ ____ _________ ____ _____ __________". Otherwise the claim will be denied.

Authorization for Release of Medical Information

Providers must maintain written acknowledgment of patients' right to privacy notification.

_________________ ___ __________ is the mutual exchange of data between a provider and a payer.

Electronic data interchange

Policyholder is also called _________.

An _____ ______ is a financial source document used by health care providers to record treated diagnosis and services rendered to the patient during the current encounter.

An encounter form is also known as a __________.

A ________ ____ can be used to create a patient medical record and financial record.

A percentage of health care cost to be paid by the patient is called ____________.

The amount the insured must pay before health care benefits are reimbursed is called _____________.

A flat payment made by the insured for each service provided is called __________.

A ___________ is an organization that performs centralized claims processing for providers and health plans.

___________ is a helth care plan designated for people 65 and older.

___________ covers low income patients.

A program that allows individuals to set aside and subsequently withdraw tax-free funds for health expenses is a __________ ___________ __________.

The method of reimbursements in which providers accept pre-established payments for providing health care services to enrollees over a period of time is called ______.

___________ ___ ___________ is a report that details to the patient the results of a processed claim.

___________ ______ is a permanent record of all financial transactions.

A claim which is correctly completed on a standardized form is known as a _________ _________.

According to federal regulations providers are to retain copies of any government insurance claim and copies of all attatchments filed by the provider for a period of ____ ________.

Patient information and health insurance records must be maintained for __ _________.

__________ _________ is a medical condition that was diagnosed and/or treated with a specified period of time immediately preceding an enrollee's effective date of coverage.

An insurance company has the right to cancel a patient's policy if the patient fails to disclose any preexisting conditions.

___________ _________ is performed to review for medical necessity of inpatient care prior to the patient's admission

Preadmission certification

An ______ _____ can be converted in an inpatient admission.

An ___ is a letter written and signed by the provider that explains why a claim should be reconsidered for payment.

A claim is considered delinquent when it is _____ ___ past due.

Funds received by a provider or beneficiaries in excess of amounts due or payable under the Medicare or Medicaid statutes or regulations are called _________________.

The abbreviation OCR stands for _________ ______ _________ and the main benefit is to increase claims processing productivity.

Birth dates are usually entered on the CMS-1500 in the format __ __ ____.

The proper way to enter a SS # on the CMS-1500 is without dash or spaces.

On the claim always leave the _________ ______ ___ _____ entry free.

_____ ______ _________ ________ is the first code to enter in block 21.

The first listed diagnosis

A maximum of ______ ICD-9-CM codes may be entered on the CMS-1500 claim.

Never use a diagnosis as "rule out", "probable", "versus".

Outpatient surgery and surgeon's charges for inpatient surgery are billed according to the ________ _____.

________ is an important part of the insurance specialist's job.

_____ means employer identification number and is different from SS.