4030 wk3 Word Scramble
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Question | Answer |
ABN | ADVANCE BENEFICIARY NOTICE |
EOB | EXPLANATION OF BENEFITS |
UCR | USUAL CUSTOMARY REASONABLE |
RBRVS | RESOURCE-BASED RELATIVE VALUE |
E & M | EVALUATION AND MANAGEMENT |
Rt | RIGHT |
Lt | LEFT |
HTN | HYPERTENSION |
FI | FISCAL INTERMEDIATE |
Diag | DIAGNOSIS |
UTI | URINARY TRACT INFECTION |
OIG | OFFICE OF THE INSPECTOR GENERAL |
HIPAA | HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT |
CMS | CENTERS FOR MEDICARE AND MEDICAID SERVICES |
S/P | STATUS POST |
ADVANCED BENEFICIARY NOTICE | a form stating that the service may not be covered must be signed in advanced before service is done |
CHARGE TICKET | a document used by the practice to aid in insuring that correct codes are being used for billing and coding |
OFFICE OF THE INSPECTOR GENERAL | has the authority to suspend exclude terminate and impose fines and penalties on providers, practitioners that commit fraud |
FALSE CLAIMS ACT | a federal law that allow people not affiliated w/ the gov. to report fowl actions against federal contractor claiming fraud against the government fna the whislebloweres act |
FRAUD | an intentional misrepersentation of the facts to deceive or mislead |
ABUSE | incidents or practices, not usually considered fraudulent, that are inconsistent w/ accepted sound medical buniness or fical practices |
JOINT COMMISSION ON THE ACCREDITATION OF THE HOSPITAL ORGANIZATION | requirements for reimbursment by a third-party carrier validates by quality of care and provide a competitive edge over facility that are not a credit. |
WHISTLE BLOWERS PROTECTION ACT | ropart physicans suspected of defrauding the federal gov. |
QUI TAM PROVISION | an action to recover a penalty brought on by an informer in a situation in which one portion of recovery goes to the informer and the other portion to the state or government |
MANUEL REVIEW AND FLAG | all claims even those that are typicaly wiuld be processed automatically will be flaged if a practice or provider is found guilty of fraud. |
LINE ITEM | represent one line of the claim |
COMPLAINCE PROGRAM | a process of meeting regualtions, recommedations and expectations of federal and state agenies that pays for healtth service. |
HEALTH INSURANCE PORTABLY AND ACCOUNTABLE ACT | a set of standards that are required the the confidentiality of patients records and the processing of health care claims. |
EXPLANATION OF BENEFITS | a document detailing services billed and descibing payment determinatons. |
FISCAL INTEREDIARY | an oganization that processes claims for care recived |
CLEAN CLAIM | a claim submitted on time w/ all the nessary info so that it can be processed and paid promptly |
Created by:
markitaboyles
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