Terms and Explanations

Question 1

What does “PA” stand for?

Answer 1

Physician Assistant

Question 2

What does “EMT” stand for?

Answer 2

Emergency Medical Technician

Question 3

What does “PCT” stand for?

Answer 3

Patient Care Technician

Question 4

What does “EHRs” stand for?

Answer 4

Electronic Health Records

Question 5

What’s another name for “Insurance?”

Answer 5

Carrier

Question 6

What’s another name for “Medical Insurance?”

Answer 6

Health Insurance / Healthcare Provider

Question 7

Define: First-Party

Answer 7

Patient / Guarantor

Question 8

Define: Second-Party

Answer 8

Provider / Physician, Clinic or Hospital

Question 9

Define: Third-Party

Answer 9

Insurance company for whom a claim has been submitted for repayment.

Question 10

Define: Policy

Answer 10

A contract that states in the case of certain injuries or illnesses, the insurance carrier will pay some or all of the medical bills of the insured.

Question 11

Define: Premiums

Answer 11

Payments made in advance, either monthly, quarterly, semi-annually or annually.

Question 12

Define: Benefits

Answer 12

When an insurance company pays for medical treatment based on a policy.

Question 13

Define: Reimbursement

Answer 13

The compensation or repayment for healthcare services.

Question 14

Define: Participating Providers

Answer 14

“Contracted” physicians working with specific insurance companies.

Question 15

Define: Allowable Charge

Answer 15

The maximum amount an insurance carrier will pay for a specific service; agreed to and accepted by participating providers.

Question 16

Define: Usual, Customary and Reasonable

Answer 16

The maximum amount the insurer will consider eligible, for services rendered.

Question 17

Define: Inpatient Setting

Answer 17

A facility, other than psychiatric, that provides diagnostic, therapeutic (both surgical and non-surgical) and rehabilitation services by or under the supervision of physicians to admitted patients.

Question 18

Define: Outpatient Setting

Answer 18

A provider’s office, urgent care center, emergency department or an outpatient surgical facility.

Question 19

Who composes the “Chief Complaint?”

Answer 19

A physician

Question 20

What is a “Chief Complaint?”

Answer 20

A concise statement that describes why a patient is seeking treatment.

Question 21

Define: Diagnosis

Answer 21

The physician’s opinion about what is wrong with the patient or what is causing the patient’s complaint.

Question 22

Define: Procedure

Answer 22

Anything the physician does to determine a diagnosis and help the patient heal.

Question 23

What do Nurses do?

Answer 23

Follow through with treatments physicians prescribe, give injections, check a patient’s vital signs, as well as assist in surgery.

Question 24

What do Nurse’s Assistants do?

Answer 24

Help nurses with daily duties, such as paperwork, general organization and taking a patient’s temperature, weight and blood pressure.

Question 25

What do EMTs do?

Answer 25

Stabilize patients who have a wide variety of emergency medical conditions.

Question 26

What do Paramedics do?

Answer 26

Stabilize patients, and begin treatments to cure patients, such as administering medication.

Question 27

What are the two duties of a Medical Assistant?

Answer 27

Administrative and Clinical.

Question 28

What are the 5 basic responsibilities of a Health Document Specialist?

Answer 28

1) Transcribe/Edit Dictation. 2) Code Records. 3) Complete and Submit Insurance Claim Forms. 4) Follow-Up on Claims and Bills. 5) Secondary Insurance Claims and Patient Billing.

Question 29

What is "The Customary Maximum?"

Answer 29

The fee charged by most providers in the community.

Question 30

What is a "Fixed Fee Schedule?"

Answer 30

A predetermined dollar amount covered by the insurance company for a specific medical service or procedure.

Question 31

Define: Deductible

Answer 31

The dollar amount an individual must pay before insurance benefits begin.

Question 32

Define: Copayment

Answer 32

A flat amount of money paid by the patient, usually at the time of service.

Question 33

What does "EOB" stand for?

Answer 33

Explanation of Benefits: A document that explains how much the insurance company paid and how much is disallowed.

Question 34

What is Preauthorization?

Answer 34

The process of notifying an insurance company before hospitalization, surgery or tests.

Question 35

What are Visitation Limits?

Answer 35

A set number of "visits" to a specialist that a person may make, or the number of special treatments a patient may have, such as physical therapy sessions. Insurance companies set them.

Question 36

What is the CMS-1500?

Answer 36

The standard claim form used to request payment for services rendered by the healthcare provider. Usually, used by physician's offices and government programs.

Question 37

What is the UB-04?

Answer 37

The uniform claim form used in hospitals and other inpatient settings.

Question 38

What is Medical Coding?

Answer 38

The translation of medical record documentation of illnesses, diseases, injuries, treatments and procedures into numeric and alphanumeric characters.

Question 39

What is the IDC-9-CM stand for, and what is it?

Answer 39

International Classification of Diseases, 9th Revision, Clinical Modification: A manual used to determine diagnostic codes for both inpatient and outpatient services, as well as inpatient procedures.

Question 40

What does "CPT" stand for, and what is it?

Answer 40

Current Procedural Terminology: A manual developed and maintained by the American Medical Association (AMA), containing codes that describe the procedures and services performed by the provider for outpatient services.

Question 41

What are Category I Codes?

Answer 41

5-Digit codes that include all "regular" CPT codes in the six main sections of the manual.

Question 42

What are Category II Codes?

Answer 42

A special collection of CPT codes that providers use to track and measure performance internally. Insurance companies do no use these codes to determine reimbursement. Instead, physicians use them to see just how much work they do in certain situations. (Category II Codes are optional.)

Question 43

What are Category III Codes?

Answer 43

Temporary codes, unlike Category I Codes, listed in numeric order, not by anatomic location. (They are removed from the CPT Manual after a maximum of two 5-years terms if they are not adopted.)

Question 44

What is CMS and who administers it?

Answer 44

Center for Medicare and Medicaid Services. Administered by the U.S. Department of Health and Human Services (HHS).

Question 45

What is the HCPCS Level II?

Answer 45

Healthcare Common Procedure Coding System Level II: 5-digit, alphanumeric codes developed for physician and non-physician services that the CPT manual does not cover. These codes include drugs, durable medical equipment, ambulance services and prosthetic procedures.