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Answers telephones, greets patients, and updates and files patient medical records
Medical Assistant
Communicates with providers about documentation and compliance issues
Reviews claims for third party payers to determine whether costs are reasonable and medically necessary
Health insurance specialist
Schedules hospital admission and laboratory services
Medical Assistant
Verifies claims against third party payer guidelines to authorize appropriate payments
Health Insurance Specialist
Certified Coding Specialist
American Health Information Management Association AHIMA

Certified Medical Reimbursement Specialist
American Medical Billing Association AMBA
Certified Professional Coder
American Academy of Professional Coders AAPC
Certified Electronic Claims Professional
National Association of Claims Assistance Professionals NACAP
Fellow, Life, and Health Claims
International Claim Association ICA
American Association of Medical Assistants AAMA
Medical Assistant
American Academy of Professional Coders AAPC
National Association of Claims Assistance Professionals NACAP
Health Insurance Specialist
American Health Information Management Association AHIMA
American Medical Technologists
Medical Assistant
Race, ethnicity, type of facility, and type of unit
Small code set
Substances, equipment, supplies, actions take to prevent, diagnose, treat, or manage diseases, injuries and impairments, causes of disease, injury, impairment, diseases, injuries, impairments, manifestations
Large code set
SNOMED (Systematized Nomenclature of Medicine)
Medical nomenclature
National Health Services's Clinical Terms Version 3
Medical nomenclature
ICD-9-CM (Int'l classification of disease 9th ed, clinical modification)
Coding system
Coding system
Read codes
Medical nomenclature
Continuity of patient care
Primary purpose
Evaluating quality of patient care
secondary purpose
Providing data for use in clinical research
secondary purpose
Serving medicolegal interests of patient, facility, and providers
secondary purpose
Submitting information to payers for reimbursement
secondary purpose
The business record for a patient encounter that documents health care services provided to a patient is called a
medical record
Patient identification information collected according to facility policy, which includes the patient's name, date of birth, and so on, is called
demographic data
A paper based record is called a _______ record
The patient's diagnosis must justify diagnostic and/or therapeutic procedures or services provided, which is called
medical necessity
The primary purpose for the record is to provide for __________, which involves documenting patient care services so that others who treat the patient have a source of information on which to base additional care.
continuity of care
When reports are organized according to data source, the _________ record is being used.
source oriented
When reports are arranged in strict chronological order, or reverse date order, the ___________ record is being used
An automated record that is created on a computer using a keyboard, a mouse, an optical pen device, a voice recognition, a scanner, or a touch screen is called the
electronic medical record EMR
An automated record that provides an alternative to traditional microfilm or remote storage systems because patient records are converted to an electronic image and saved on storage media is called
optical disk imaging or doc imaging
The equipment that stores large numbers of optical disks resulting in huge storage capabilities is called
Appointment scheduling and claims processing are processes associated with _______ software
medical management
Hospital coders use automated ______ software to collect and report inpatient and outpatient data for statistical analysis and reimbursement purposes
case abstracting
Physician's offices submit data to third party payers on the _______ claim
Hospitals submit data to third party payers on the _______ claims
Claims are denied if _______ of procedures or services is not established
medical necessity
ICD-9-CM was adopted in ___ as the official classification system for assigning codes to diagnoses and procedures
The ICD-9-CM was originally published as ___ volumes
The US Dept of Health and Human Svcs agencies responsible for overseeing all changes and modifications to ICD-9-CM are_____
National Center for Health Statistics NCHS and Centers for Medicaid and Medicare Svcs CMS
The _____ requires all code sets to be valid at the time services are provided, which means that midyear and end of year coding updates must be implemented immediately so accurate codes are reported on claims
Medicare Prescription Drug Improvement, and Modernization Act MMA
Updateable coding manuals which publishers offer as an annual ______service, are popular because coders can remove outdated pages and insert updated pages into the binders
The coding process is automated when computerized or web based ______ software is used instead of coding books to lcoate codes manually - the coder uses the software's search feature to locate and verify codes
The mandated reporting of ICD-9-CM diagnosis codes on Medicare claims was implemented by the _______
Medicare Catastrophic Coverage Act of 1988
Reporting ICD-9-CM codes on submitted claims ensures the ______ of procedures and services provided to patients during an encounter which is defined as the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury
medical necessity
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