click below
click below
Normal Size Small Size show me how
Stack #598708
Terminology Mod 150, Unit 1
Question | Answer |
---|---|
ALJ | administrative law judge |
Appeal | A request for review of an insurance claim that has been underpaid or denied by an insurance company to receive additional payment |
CMS | Center for Medicare and Medicaid Services |
DAB | Departmental Appeal Board |
Delinquent claim | an insurance claim submitted to an insurance company, for which payment is overdue |
Denied paper or electronic claim | an insurance claim submitted to an insurance company which payment has been rejected owing to a technical error or because of medical coverage policy issues |
ERISA | Employee Retirement Income Security Act |
Explanation of Benefits (EOB) | A document detailing services billed and describing payment determinations; also known in Medicare, Medicaid, and some other programs as a remittance advice |
FTC | Federal Trade Commission |
HCPCS | Healthcare Common Procedure Coding System |
HIPAA | Health Insurance Portability and Accountability |
HMO | health maintenance organization |
HO | hearing officer |
Inquiry | Tracer; an inquiry made to an insurance company to locate the status of an insurance claim |
Lost claim | an insurance claim that cannot be located after sending it to insurer |
Medigap(MG) | A specialized supplemental insurance policy devised for Medicare beneficiary that covers the deductible and copayment amounts typically not covered under the main Medicare policy written by a nongovernmental third-party payer |
NPI | National Provider Identifier |
Overpayment | Money paid over and above the amount due by the insurer or patient |
Peer review | the review of a patients case by one and more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care |
Rebill (resubmit) | to send another request for payment for an overdue bill to either the insurance company or patient |
Rejected claim | an insurance carrier that is discarded by the system because of a technical error or because it does not follow Medicare instructions |
Remittance advice (RA) | A document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program |
Review | to look over a claim to access how much payment should be made |
Suspended claim | an insurance claim that is processed by the insurance carrier but held in an indeterminate (pending) state about payment either because of an error or the need for additional information |
Tickler file | an alternative manual method used to track pending or resubmitted insurance claims |
TRICARE | A three-option managed health care program offered to spouses and dependents of service personal with uniform benefits and fees implemented nationwide by the federal government |
UPIN | Unique Provider Identification Number |
Aging reports | each month a report should be run that will indicate which claims are outstanding |
Ambi- | both, both sides, around, about |
Bi- | two, double |
Circum- | around |
Deca- | ten |
Infer- | below |
Inter- | between |
Intra- | within |
Nulli- | none |
Poly- | many, much, excessive |
Super- | upper, above |
-algesia | condition of pain |
-blast | immature cell, germ cell |
-cyst | bladder, sac |
-graphy | recording |
-lepsy | seizure |
-lysis | destruction, separation -ectomy |
-genesis | formation, produce |
-orexia | appetite |
-rrhage | to burst forth bursting forth |
-rrhaphy | suture |
-rrhexis | rupture |