Question | Answer |
abn | advance beneficiary notice |
cms | centers for medicare and medicaid services |
ssi | social, security income |
hcfa | health care financing administration |
cms-1500 | center for medicare & medicaid services health ins claim form |
esrd | end stage renal disease |
mma | medicare prescription drug improvement & modernization act |
mg | medigap |
eob | explanation of benefits |
cci | correct coding initiative |
rbrvs | resource based relative value scale |
rvu | relative vale unit |
pqri | physician quality reporting initiative |
lcd | local coverage decision |
lcd | local coverage decision |
sof | signature on file |
ra | remittance advice |
era | electronic remittance advice |
advance beneficiary notice | an agreement given to the pt to read and sign before rendering a service that maybe denied or paid. |
assignment | an agreement signed by the pt that assigns the right to receive payment for the services from the insurance |
correct coding initiative | federal legislation that attempt to eliminate unbundleing or other inappropriate reporting of procedural codes for professional medical services rendered to patients |
crossover claim | a claim automatically sent electronically to the secondary payer when a person has both primary and secondary insurance |
hospice | a public agency or private organization that is primarily engaged in providing pain relief, symptom management & supportive service to terminally ill people & their families. |
respite care | a short term inpatient stay |
medical necessity | performance of service & procedures that are consistent with diagnosis |
medicare part A | hospital coverage, no charge |
medicare part b | out patient coverage |
medi/medi | medicare medicaid |
remittance advice | a document detailing services billed & describing payment determination issued to providers |
medicare secondary payer | the primary insurance plan of a medicare beneficiary that must pay for any medical care or service first before medicare is sent a claim |
whistle blowers | informants who report physicians suspected of defrauding the federal government |
Established patient | an individual who has received professional services with in the past 3 years |
new patient | an individual who has NOT received any professional services from the physician or another physician who belongs to the same group practice within the past 3years |
review of systems | an inventory of body systems related to chief complaint |
key elements | history, physical examination medical decision making are the individualized steps in the identification of the correct e& m procedure code for services performed |
initial visit | the first visit during an episode of care. |
subsequent visit | after the initial visit during an episode of care |
medicare | a federal health insurance program for 65plus, retired from railroad, disabled individuals, & all ages with end stage renal disease. |