| A | B |
|---|
| Comprehensive billing/insurance coding certification exam that has high standards | CMRS (Certified Medical Reimbursement Specialist) |
| This worker submits written confirmation authorizing treatment to a provider and typically coordinates care for chronic conditions | case manager |
| Insurance commonly purchased by employers | bonding insurance |
| A typical responsibility of a health insurance specialist | Correcting claims processing errors |
| The process of classifying diagnoses, procedures, and services | coding |
| Insurance available through employers, labor unions, consumer health cooperatives, and other organizations | group health insurance |
| The report that details the results of processing a claim that is sent to a patient is the | explanation of benefits |
| A coding system used for reporting procedures and services in physician offices and is published by the AMA | CPT |
| Electronic claims processing sends data through | a standardized, machine-readable format |
| Agency formerly known as the HCFA | Centers for Medicare and Medicaid Services |
| The hold harmless clause states | a patient is not responsible for paying what insurance denies |
| Disability insurance typically provides what type of compensation to the injured person | financial |
| The concept that every procedure or service reported to a third-party payer must be linked to a condition that justifies the service is called medical ______. | necessity |
| Health care coverage that allows employees to extend health insurance beyond a termination date: | COBRA |
| An official from Baylor University in Dallas developed what is recognized now as the first _____ policy. | pre-paid health |
| In the 1940s, this began being offered to full-time employees, and employers paid part or all of premium costs: | group health insurance |
| Liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatment: | medical malpractice insurance |
| A ____ delivers health care services using both an HMO network and traditional indemnity coverage so patients can seek care outside the network: | point-of-service |
| Provides accreditation of a variety of health-care organizations | JCAHO |
| Tax-exempt account offered by employers with any number of employees which individuals use to pay health care bills | FSA |
| Prevents providers from discussing all treatment options | gag clause |
| Combines health care delivery with the financing of services provided | managed care |
| Primary care provider for essential health care services | gatekeeper |
| Training areas for a health insurance specialist: | anatomy and physiology, coding, medical terminology, and internet use |
| Coding system used to report diagnoses and reasons for encounters on physician office claims | ICD-9-CM |
| Mandated by governments, and requires employers to cover medical expenses and lost wages for workers injured on the job or those who have developed job-related disorders | worker's compensation insurance |
| Respondeat Superior | Latin for let the master answer and means the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment |
| liability insurance | policy that covers losses to a 3rd party caused by an object owned by the insured, or on the premises |
| A government-sponsored health program that provides benefits to indigent patients | Medicaid |
| A coding system used to classify a medical condition | ICD-9-CM |
| The process of taking and passing credentialing exams | professional certification |
| Government-sponsored health care program for Americans over the age of 65. | Medicare |
