Understanding Health Insurance Ch.5
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| National Drug Code | maintained by the FDA; identifies prescription drugs and some OTC products.
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| Health Plan Identifier | unique identifier is assigned to 3rd party payers.
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| subpoena | an order of the court that requires a witness to appear at a particular time and place to testify.
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| medical review | a review of claims to determine whether services provided are medically reasonable and necessary.
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| upcoding | assignment of an ICD-10-CM diagnosis code that does not match patient record documentation for the purpose of illegally increasing reimbursement.
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| National Provider Identifier | unique identifier to be assigned to health care providers.
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| deposition | legal proceeding during which a party answers questions under oath.
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| breach of confidentiality | unauthorized release of patient information to a 3rd party.
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| confidentiality | restricting patient information access to those with proper authorization and maintaining the security of patient information.
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| overpayment | funds that a provider or beneficiary has received in excess of amounts due and payable under Medicare and Medicaid statutes and regulations.
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| interrogatory | documents containing a list of questions that must be answered in writing.
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| abuse | actions inconsistent with accepted, sound medical business, or fiscal practices.
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| privileged communication | private information shared between a patient and health care provider.
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| qui tam | who as well for the king as for himself sues.
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| civil law | area of law not classified as criminal.
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| authorization | document that provides official instruction.
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| Part A/B Medicare Administrative Contractor (A/B MAC) | an organization that contracts with CMS to process claims and perform program integrity tasks for Medicare Part A&B and DMEPOS.
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| privacy | right of individuals to keep their information from being disclosed to others.
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| fraud | intentional deception or misrepresentation that could result in an unauthorized payment.
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| criminal law | public law governed by statute or ordinance that deals with crimes and their prosecution.
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| case law/common law | based on a court decision that establishes a precedent.
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| whistleblower | individual who makes specified disclosures relating to the use of public funds.
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| medical identity theft | occurs when someone uses another person's name and/or insurance information to obtain medical and/or surgical treatment, prescription drugs, and MDE. Can also occur in a medical setting.
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| listserv | subscriber-based questions-and-answer forum that is available through email.
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| subpoena duces tecum | requires documents
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| decrypt | to decode an encoded computer file so that it can be viewed.
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| UB-04 | insurance claim or flat file used to bill institutional services, such as services performed in hospitals.
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You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
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Created by:
wendylou421
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