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week 1 terms

ABN advance beneficiary notice
MMA medicare prescription improvement & modernization act
CMS centers for medicare and medicaid services
SOF signature on file
SSI social security income
HCFA health care financing administration
CMS-1500 centers for medicare and medicaid services health insurance claim form
RBRVS resource based relative value scale
RVU relative value unit
RA remittance advice
MG medigap
ERA electronic remittance advice
PDP private prescription drug plan
EOB explaniation of benefits
CCI correct coding initiative
ESRD end stage renal disease
LCD local coverage decisions
advanced beneficiary notice an agreement given to the patient to read and sign before rendering a service that maybe denied or paid
assignment an agreement signed by the patient that assigns the right to recieve payment for the services from the insurance
correct coding initiative federal legislation that attempts to eliminate unbundling or other inappropriate reporting of procedure codes for professional medical services rendered to patients
crossover claim a calim automatically sent electronically to the secondary payer when a person has both primary and secondary insurances
hospice a public agency or private organization primarily engaged in providing pain relief symptom management or terminally ill and their families
respite care short term inpatient stay for a terminally ill patient to give temporary relief
medical necessity the performance of services and procedures that is consistant with the diagnosis
medicare part a hospital coverage no charge
medicare part b outpatient coverage
medi-medi individual who recieves medicaid and medicare simutaneously
remittance advice document detailing services billed and describing payment determination issued to providers
medicare secondary payer primary insurance plan of medicare beneficiary that must pay for any medicare or services first before medicare is sent a claim
whistleblowers suspected or defrauding the federal government
established patient individual who has recieved professional care within the past 3 years from the physician or another physician in the same group practice
new patient individual who has not recieved any professional care within the past 3 years from the physicain or another physcian in the same group practice
review of systems inventory of systems related to the chief complaint
key elements history physical examination medical decision making are the individualized steps in the identification of the correct e/m procedure codes for services performed
initial visit first visit during an episode of care
subsequent visit visits after the initial or first visit of an episode of care
medicare a federal health insurance program for people over 65 or certain disabled/blind people or renal disease regardless of income
Created by: secretsluv