Medical Coding Abbreviations/Definitions

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CMS - THE CORRECT ANSWER IS Centers for Medicare and Medicaid Services AAMA - THE CORRECT ANSWER IS American Association of Medical Assistants DRG - THE CORRECT ANSWER IS Diagnosis-Related Group... HMO - THE CORRECT ANSWER IS Health Maintenance Organization AR (A/R) - THE CORRECT ANSWER IS Accounts Receivable HIPAA - THE CORRECT ANSWER IS Health Insurance Portability and Accountability Act PCP - THE CORRECT ANSWER IS Primary Care Provider/Physician EOB - THE CORRECT ANSWER IS Explanation of Benefits RA - THE CORRECT ANSWER IS Remittance Advice PHI - THE CORRECT ANSWER IS Protected Health Information NPI - THE CORRECT ANSWER IS National Provider Identifier DME - THE CORRECT ANSWER IS Durable Medical Equipment COB - THE CORRECT ANSWER IS Coordination of Benefits PAR - THE CORRECT ANSWER IS Participating MTF - THE CORRECT ANSWER IS Military Treatment Facility EDI - THE CORRECT ANSWER IS Electronic Data Interchange OSHA - THE CORRECT ANSWER IS Occupational Safety and Health Administration CPC - THE CORRECT ANSWER IS Certified Professional Coder CCS-P - THE CORRECT ANSWER IS Certified Coding Specialist-Physician Based NON-PAR - THE CORRECT ANSWER IS Non-Participating PPO - THE CORRECT ANSWER IS Preferred Provider Organization MC - THE CORRECT ANSWER IS Managed Care PA NUMBER - THE CORRECT ANSWER IS Prior Authorzation Number SOAP - THE CORRECT ANSWER IS Subjective, Objective, Assessment, Plan HCPCS - THE CORRECT ANSWER IS Healthcare Common Procedures Coding System ICD - THE CORRECT ANSWER IS International Classification of Diseases CPT - THE CORRECT ANSWER IS Current Procedural Terminology NOS - THE CORRECT ANSWER IS Not Otherwise Specified NEC - THE CORRECT ANSWER IS Not Elsewhere Classifiable ABN - THE CORRECT ANSWER IS Advance Beneficiary Notice CMA (who offers this certification?) - THE CORRECT ANSWER IS Certified Medical Assistant (AAMA) Copay - THE CORRECT ANSWER IS the set amount that the patient pays when medical services are received Coinsurance - THE CORRECT ANSWER IS percentage of charges that an insured person must pay for health care services after payment of the deductible amount Fee-for-Service - THE CORRECT ANSWER IS charging based on each service performed Capitation - THE CORRECT ANSWER IS payment to a provider that covers each plan member's health care services Pre-existing - THE CORRECT ANSWER IS condition that existed prior to an insurance policy Managed Care - THE CORRECT ANSWER IS system that combines the financing and the delivery of appropriate health care services Referral - THE CORRECT ANSWER IS Transfer of patient from one physician to another Policy Holder - THE CORRECT ANSWER IS person who purchased the insurance plan Insured - THE CORRECT ANSWER IS person who purchased the insurance plan Guarantor - THE CORRECT ANSWER IS person paying the money; person who purchased the insurance plan Subscriber - THE CORRECT ANSWER IS person who purchased the insurance plan Medicare Part A - THE CORRECT ANSWER IS pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care Medicare Part B - THE CORRECT ANSWER IS physician services, outpatient hospital services, durable medical equipment, and other services and supplies Medicaid - THE CORRECT ANSWER IS federal program that provides medical benefits for low-income people Medigap - THE CORRECT ANSWER IS refers to situations not covered by medicare insurance Chief Complaint - THE CORRECT ANSWER IS patient's description of symptoms Aging Report - THE CORRECT ANSWER IS list of accounts receivable amounts and their due dates Correcting Medical Records - THE CORRECT ANSWER IS draw a single line through the error, make the correction, and indicate your initials and the current date Cross-over Claims - THE CORRECT ANSWER IS claim automatically sent to 2nd insurance - Medicare to Medicaid Clean Claim - THE CORRECT ANSWER IS a claim that is accepted by a health plan for adjudication (goes through the first time) Clearinghouse - THE CORRECT ANSWER IS send all claims to clearing house and they convert into different insurances Write Off - THE CORRECT ANSWER IS to deduct an amount from a patient's account Subpoena - THE CORRECT ANSWER IS a court order requiring appearance in court Adjudication - THE CORRECT ANSWER IS an amount entered to a pt account to change balance Informed Consent - THE CORRECT ANSWER IS patient authorizes consent for medical treatment Standard of Care - THE CORRECT ANSWER IS state-specified performance measures for the delivery of health care Birthday Rule - THE CORRECT ANSWER IS the guidelines that determines which of two married parents with medical coverage from different employers has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary Primary Insurance - THE CORRECT ANSWER IS health plan that pays benefits first Secondary Insurance - THE CORRECT ANSWER IS the health plan that pays benefits after the primary plan when a patient is covered by more than one plan Post an Entry - THE CORRECT ANSWER IS to enter data in the financial record Self-pay Patient - THE CORRECT ANSWER IS patient has no insurance and is responsible to pay their bill to the doctor New Patient - THE CORRECT ANSWER IS defined as one who has not received medical services w/in the last 3 years Established Patient - THE CORRECT ANSWER IS a patient who has been seen by a provider in the practice in the same specialty within three years Deductible - THE CORRECT ANSWER IS an amount to be paid before insurance will pay Premium - THE CORRECT ANSWER IS the amount the policyholder must pay for insurance coverage CMS 1500 - THE CORRECT ANSWER IS health insurance claim form (paper) Code Linkage - THE CORRECT ANSWER IS the connection between a service and a patient's condition or illness; establishes the medical necessity of t [Show More]

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