Miscellaneous Quiz / Healthcare Billing Terms and Form Names

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Can you name the Healthcare Billing Terms and Form Names?

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DefinitionTerm
A Medicare policy to determine what is and what is not covered for an encounter. It is based on medical necessity.
Both edit-checks a claim and determines its medium (paper or electronic)
Codes which charge for supplies and equipment used in an outpatient setting.
A document from the payor explaining what invoices are being paid and why.
Codes which charge for the procedures performed in an outpatient setting.
Electronic form of remittance advice.
A code that identifies a specific accomodation or service. It is a group of individual charges. Payors will either pay the whole claim, or they'll pay for each of these charges.
Hospital Billing claim in the paper format.
An electronic request for claim status. Sent by provider to payor.
DefinitionTerm
Professional Billing claim in the paper format.
Medicare's identification number it assigns to each claim received to keep track of it.
System developed my CMS to promote national coding methodologies and reduce duplicate entries
A code used to charge for procedures performed in an inpatient stay.
An electronic response to a request for claim status. Sent from payor back to provider.
Professional AND Hospital Billing claim in the electronic format.
A diagnosis-related charge for an outpatient visit. Patients can have multiple groups of these charges.
A designation that Medicare gives to qualifying organizations which allows them to bill Medicare on UB and 1500--not just on one CMS form.
A Diagnosis-related charge for inpatient stays. Only one may be assigned to a patient.

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