4/12/25, 8:25 Glossary NHA CBCS |
PM
GLOSSARY NHA CBCS EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS VERIFIED
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Save
Practice questions for this set
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Specifically prohibits any payment by Medicare for services or medically necessary
supplies that are not submitted electronically
Select the correct term
Administration Simplification Compliance
1 2unbundling
Act (ASCA)
3Abstracting 4remittance advice remark code (RARC)
Don't know?
Terms in this set (121)
write-off The difference between the provider's actual charge and the allowable charge.
V codes Codes for reasons other than sickness or injury. Specific to ICD-9-CM
three-digit code that describes a classification of a product or service provided to
UB-04 code
the patient
Using multiple codes that describe different components of a treatment instead of
unbundling
using a single code that describes all steps of the procedure
upcoding use of a procedure code that provides a higher payment
utilization review process of evaluating the appropriateness of services provided
referral Written recommendation to a specialist
reimbursement Compensation or repayment for healthcare services
The report sent from the third-party payer to the provider that reflects any
Remittance advice (RA)
changes made to the original billing
remittance advice remark code (RARC) code that explains the reason for a payment adjustment
1/
5
, 4/12/25, 8:25 Glossary NHA CBCS |
PM
four-digit code that identifies specific accommodation, ancillary service, or billing
Revenue Code
calculation related to services on a bill
staff model HMO that provides hospitalization and physician services through its own staff.
Prohibits physicians or their family members who own health care facilities from
Stark Law
referring patients to those with whom they have a financial relanionship
Subscriber number Unique code used to identify a subscriber's policy.
Purchaser of the insurance or the member of group for which an employer or
Subscriber
association as purchased insurance.
Supervising provider The physician monitoring a patients care
Tier 1 Providers and facilities in a PPO's network.
Providers and facilities within a broader, contracted network of the insurance
Tier 2
company.
Tier 3 Providers and facilities out of the network.
Tier 4 Providers and facilities not on the formulary
Timely filing requirement Within 1 calendar year of a claim's date of service.
Patient Responsibility the amount the patient owes
Preauthorization Prior approval for treatment and procedures
A review that looks at whether the procedure could be performed safely but less
Precertification
expensively in an outpatient setting.
Predetermination A written request for a verification of benefits.
Plan that allows patients to use physicians, specialists, and hospitals in the plan's
Preferred Provider Organization (PPO)
network and receive a greater discount on services.
preferred provider Tier 2 provider
Primary Insurance health plan that pays benefits first
number indicating that the insurance company has been notified and has
prior approval number
approved services before they were rendered
A HIPAA rule that establishes protections for the privacy of individual's health
Privacy Rule
information.
Plan that allows patients to go to any physician, other health care professional, or
private fee-for-service plan
hospital as long as the providers agree to treat those patients.
private insurance the insured pays a monthly premium for insurance plan to company
ICD procedure codes (ICD-9-CM volume 3 or ICD-10-PCS), Current Procedural
procedure code Terminology (CPT) codes, or the Healthcare Common Procedures Coding System
(HCPCS) that represents the procedure or service.
Protected Health Information (PHI) Information that contains one or more patient identifiers.
A physician or other licensed health care professional who prescribes services for
Ordering provider
a patient
Other Adjustments used when no other code applies to the adjustment
out-of-network provider that does not have a participation agreement with a plan
A predetermined amount after which the insurance company will pay 100% of the
Out-of-pocket maximum
cost of medical services.
Plan that provides focused, specialized health care for specific groups of people,
Medicare specialty plan such as those who have both Medicare and Medicaid, live in a long-term
care facility, or have chronic medical conditions.
Document that outlines the amounts billed by the provider and what the patient
Medicare Summary Notice (MSN)
must pay the provider.
2/
5
PM
GLOSSARY NHA CBCS EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS VERIFIED
Leave the first rating
Save
Practice questions for this set
Learn 1/7 Study using Learn
Specifically prohibits any payment by Medicare for services or medically necessary
supplies that are not submitted electronically
Select the correct term
Administration Simplification Compliance
1 2unbundling
Act (ASCA)
3Abstracting 4remittance advice remark code (RARC)
Don't know?
Terms in this set (121)
write-off The difference between the provider's actual charge and the allowable charge.
V codes Codes for reasons other than sickness or injury. Specific to ICD-9-CM
three-digit code that describes a classification of a product or service provided to
UB-04 code
the patient
Using multiple codes that describe different components of a treatment instead of
unbundling
using a single code that describes all steps of the procedure
upcoding use of a procedure code that provides a higher payment
utilization review process of evaluating the appropriateness of services provided
referral Written recommendation to a specialist
reimbursement Compensation or repayment for healthcare services
The report sent from the third-party payer to the provider that reflects any
Remittance advice (RA)
changes made to the original billing
remittance advice remark code (RARC) code that explains the reason for a payment adjustment
1/
5
, 4/12/25, 8:25 Glossary NHA CBCS |
PM
four-digit code that identifies specific accommodation, ancillary service, or billing
Revenue Code
calculation related to services on a bill
staff model HMO that provides hospitalization and physician services through its own staff.
Prohibits physicians or their family members who own health care facilities from
Stark Law
referring patients to those with whom they have a financial relanionship
Subscriber number Unique code used to identify a subscriber's policy.
Purchaser of the insurance or the member of group for which an employer or
Subscriber
association as purchased insurance.
Supervising provider The physician monitoring a patients care
Tier 1 Providers and facilities in a PPO's network.
Providers and facilities within a broader, contracted network of the insurance
Tier 2
company.
Tier 3 Providers and facilities out of the network.
Tier 4 Providers and facilities not on the formulary
Timely filing requirement Within 1 calendar year of a claim's date of service.
Patient Responsibility the amount the patient owes
Preauthorization Prior approval for treatment and procedures
A review that looks at whether the procedure could be performed safely but less
Precertification
expensively in an outpatient setting.
Predetermination A written request for a verification of benefits.
Plan that allows patients to use physicians, specialists, and hospitals in the plan's
Preferred Provider Organization (PPO)
network and receive a greater discount on services.
preferred provider Tier 2 provider
Primary Insurance health plan that pays benefits first
number indicating that the insurance company has been notified and has
prior approval number
approved services before they were rendered
A HIPAA rule that establishes protections for the privacy of individual's health
Privacy Rule
information.
Plan that allows patients to go to any physician, other health care professional, or
private fee-for-service plan
hospital as long as the providers agree to treat those patients.
private insurance the insured pays a monthly premium for insurance plan to company
ICD procedure codes (ICD-9-CM volume 3 or ICD-10-PCS), Current Procedural
procedure code Terminology (CPT) codes, or the Healthcare Common Procedures Coding System
(HCPCS) that represents the procedure or service.
Protected Health Information (PHI) Information that contains one or more patient identifiers.
A physician or other licensed health care professional who prescribes services for
Ordering provider
a patient
Other Adjustments used when no other code applies to the adjustment
out-of-network provider that does not have a participation agreement with a plan
A predetermined amount after which the insurance company will pay 100% of the
Out-of-pocket maximum
cost of medical services.
Plan that provides focused, specialized health care for specific groups of people,
Medicare specialty plan such as those who have both Medicare and Medicaid, live in a long-term
care facility, or have chronic medical conditions.
Document that outlines the amounts billed by the provider and what the patient
Medicare Summary Notice (MSN)
must pay the provider.
2/
5
