Lesson 1 Reading Assignment Chapter 1 Flashcards
(29 cards)
AAPC
Professional association, previously known as the American Academy of Professional Coders, established to provide a national certification and credentialing process, to support the national and local membership by providing educational products and opportunities to networks, and to increase and promote national recognition and awareness of professional coding.
American Association of Medical Assistants (AAMA)
Enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants’ right to practice.
American Health Information Management Association (AHIMA)
Founded in 1928 to improve the quality of medical records, and currently advances the health information management (HIM) profession toward an electronic and global environment, including implementation of ICD-10-CM and ICD-10-PCS in 2013.
bonding insurance
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.
business liability insurance
protects business assets and covers the cost of lawsuits resulting from bodily injury, personal injury, and false advertising.
Centers for Medicare and Medicaid Services (CMS)
formerly known as the Health Care Financing Administration (HCFA); an administrative agency within the federal Department of Health and Human Services (DHHS).
claims examiner
employed by third-party payers to review health-related claims to determine whether the charges are reasonable and medically necessary based on the patient’s diagnosis.
coder
applies working knowledge of coding systems, coding conventions and guidelines, government regulations, and third-party payer requirements to accurately assign ICD-10-CM/PCS and CPT/HCPCS Level II codes to diagnoses and procedures/services documented in patient records.
coding
process of reporting diagnoses, procedures, services, and supplies as numeric and alphanumeric characters (called codes) on the insurance claim.
embezzle
the illegal transfer of money or property as a fraudulent action; to steal money from an employer.
errors and omissions insurance
see professional liability insurance.
ethics
principle of right or good conduct; rules that govern the conduct of members of a profession.
health care provider
physician or other health care practitioner (e.g., physician’s assistant).
health information technicians
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.
health insurance claim
document that is electronically or manually submitted to an insurance plan requesting reimbursement for health care procedures and services provided (e.g., CMS-1500 and UB-04 claims).
health insurance specialist
person who reviews health-related claims to match medical necessity to procedures or services performed before payment (reimbursement) is made to the provider; see also reimbursement specialist.
hold harmless clause
policy that the patient is not responsible for paying what the insurance plan denies.
independent contractor
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.”
internship
nonpaid professional practice experience that benefits students and facilities that accept students for placement; students receive on-the-job experience prior to graduation, and the internship assists them in obtaining permanent employment.
medical assistant
employed by a provider to perform administrative and clinical tasks that keep the office or clinic running smoothly.
medical malpractice insurance
a type of liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatment.
medical necessity
involves linking every procedure or service code reported on an insurance claim to a condition code (e.g., disease, injury, sign, symptom, other reason for encounter) that justifies the need to perform that procedure or service.
professional liability insurance
provides protection from liability as a result of errors and omissions when performing their professional services; also called errors and omissions insurance.
professionalism
conduct or qualities that characterize a professional person.
