Term
American Medical Billing Association (AMBA)
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Definition
offers the Certified Medical Reimbursement Specialist (CMRS) exam, which recognizes competency of members who have met high standards of proficiency
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American Medical Billing Association
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| American Health Information Management Association (AHIMA) |
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Definition
| professional association that represents more than 40,000 health information management professionals who work throughout the health care industry |
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Definition
| American Health Information Management Association |
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Term
American Academy of Professional Coders (AAPC)
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| professional association established to provide a national certification and credentialing process, to support the national and local membership by providing educational products and opportunities to network, and to increase and promote national recognition and awareness of professional coding |
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Term
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Definition
| an insurance agreement that guarantees repayment for financial losses resulting from the act or failure to act of an employee. It protects the financial operations of the employer. |
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Centers for Medicare and Medicaid Services (CMS)
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Definition
formerly known as the Health Care Financing Administration (HCFA); an administrative agency within the federal Department of Health and Human Services (DHHS). |
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| process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the insurance claim. |
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Term
Current Procedural Terminology (CPT)
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Definition
| published by the American Medical Association; includes five-digit numeric codes and descriptors for procedures and services performed by providers (e.g., 99203 identifies a detailed office visit for a new patient). |
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| Current Procedural Terminology |
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electronic data interchange (EDI)
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| mutual exchange of data between provider and payer. |
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Term
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| electronic data interchange |
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electronic claims processing
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Definition
| sending data in a standardized machine-readable format to an insurance company via disk, telephone, or cable. |
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Definition
| the illegal transfer of money or property as a fraudulent action. |
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explanation of benefits (EOB)
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| report that details the results of processing a claim (e.g., prayer reimburses provider $80 on a submitted charge of $100). |
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Definition
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| national codes published by CMS, which include five-digit alphanumeric codes for procedures, services, and supplies not classified in CPT. |
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Term
Healthcare Common Procedure Coding System (HCPCS)
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Definition
coding system that consists of CPT, national codes (level II), and local codes (level III); local codes were discontinued in 2003; previously known as HCFA Common Procedure Coding System.
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Term
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Definition
| physician or other health care practitioner (e.g., physician's assistant). |
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Term
health information technician
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Definition
professionals who manage patient health information and medical records, administer computer information systems,and code diagnoses and procedures for health care services provided to patients.
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Term
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Definition
| documentation submitted to an insurance plan requesting reimbursement for health care services provided (e.g., CMS-1500 and UB-04 claims). |
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Term
health insurance specialist (reimbursement specialist)
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Definition
| person who reviews health-related claims to determine the medical necessity for procedures or services performed before payment (reimbursement) is made to the provider; see also reimbursement specialists. |
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Definition
| patient is not responsible for paying what the insurance plan denies. |
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Term
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| defined by the 'Lectric Law Library's Lexicon as "a person who performs services for another under an express or implied agreement and who is not subject to the other's control, or right to control, of the manner and means of performing the services. The organization that hires an independent contractor is not liable for the acts or omissions of the independent contractor." |
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Term
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
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Definition
| coding system used to report diagnoses (e.g., diseases, signs, and symptoms) and reasons for encounters (e.g., annual physical examination and surgical follow-up care) on physician office claims. |
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Definition
| International Classification of Diseases, 9th Revision, Clinical Modification |
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Definition
| policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on the premises owned by the insured. |
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| invovles linking every procedure or service reported to the insurance company to a condition that justifies the necessity for performing that procedure or service. |
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Term
medical malpractice insurance.
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Definition
| a type of liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatment |
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national codes (level II Codes)
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Definition
| commonly referred to as HCPCS codes; include five-digit alphanumeric codes for procedures, services, and supplies that are not classified in CPT (e.g., J-codes are used to assign drugs administered). |
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professional liability insurance (errors and omissions insurance)
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Definition
provides protection from claims resulting from errors and omissions associated with professional services provided to clients as expected of a person in their profession; also called errors and omissions insurance. |
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Definition
| protects business contents (e.g., buildings and equipment) against fire, theft, and other risks. |
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Term
remittance advice (remit)
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Definition
| electronic or paper-based report of payment sent by the payer to the provider; includes patient name, patient health insurance claim (HIC) number, facility provider number/name, dates of service (from date/thru date), type of bill (TOB), charges, payment information, and reason and/or remark codes. |
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| Latin for "let the master answer"; legal doctrine holding that the employer is liable for the actions and omissions of employees performed and committed within the scope of their employment. |
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Definition
| health care services, determined by the state, that an NP and PA can perform. |
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workers' compensation insurance
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Definition
insurance program mandated by federal and state governments, that requires employers to cover medical expenses and loss of wages for workers who are injured on the job or who have developed job-related disorders.
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| Healthcare Common Procedure Coding System |
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| principle of right or good conduct; rules that govern the conduct of members of a profession. |
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Centers for Medicare and Medicaid Services |
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| American Academy of Professional Coders |
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