Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CBCS
| Question | Answer |
|---|---|
| Medical Ethics | Standards of conduct based on moral principles |
| Compliance Regulations | Based on HIPAA |
| HIPAA | Health Insurance Portability and Accountability Act |
| What is HIPAA? | Patient privacy |
| HIPAA's two provisions | 1. Insurance reform- which provides health insurance coverage for workers and their dependents when they change or lose their jobs 2. Administrative simplification- it sets to reduce administrative cost and burdens |
| False Claims Act (FCA) | Prohibits submitting a fraudulent or false claim |
| National Correct Coding Initiative (NCCI) | To control improper coding |
| Two types of edits | -Column 1/Column 2:Identifies code pairs that shouldn't be billed together because one code includes all services described by another -Mutually Exclusive Edits:Identifies code pairs that are unlikely to be performed on the same patient on the same day |
| The Office of Inspector General (OIG) | Investigates and prosecutes healthcare fraud and abuse |
| Fraud | Intentionally deceiving information that may result in unauthorized benefits |
| Abuse | Incidents that are inconsistent |
| Patient Confidentiality | All patients have the right to privacy and all information should remain privaleged |
| Employer Liability | The license to practice medicine is governed by each state. Physicians are legally responsible for their own conduct and any actions of their employees |
| Employee Liability | Physician is responsible for mistakes made by billing services |
| Medical Record | Documentation on patients social, medical, and family history, physical examination, progress notes, and lab results corresponding to patient |
| Medical Record Retention | Varies from state to state. Deceased should be kept for at least 5 years |
| Measure | -meter |
| Abnormal condition | -osis |
| Bursting forth of blood | -rrhagia |
| Hardening | -sclerosis |
| Surgical Puncture | -centesis |
| Removal, resection, excision | -ectomy |
| Record | -gram |
| Separation, breakdown, destruction | -lysis |
| Suture | -rrhaphy |
| Opening | -stomy |
| Treatment | -therapy |
| Incision, to cut into | -tomy |
| Without | a,an- |
| Before | ante- |
| Against | -anti |
| Painful, difficult | dys- |
| Inside, within | endo- |
| Upon, above | epi- |
| Out | ex- |
| Below, defiscient | hypo- |
| Below | infra- |
| Between | inter- |
| New | neo- |
| Scanty, little | oligo- |
| All | pan- |
| Beside | para- |
| Through | per- |
| Before, infront of | pre- |
| False | pseudo- |
| Under | sub- |
| Above, beyond | supra- |
| Four | tetra- |
| Cartilage | arth-, chondro- |
| Head | cephal- |
| Gallbladder | cholecyst- |
| Vagina | colp- |
| Intestine | enter- |
| Vulva | episi- |
| Tongue | gloss- |
| Liver | hepato- |
| Uterus | hyster- |
| Abdomen | lapar- |
| Milk | lact- |
| Stone | lith- |
| Breast | mast- |
| Birth | nat- |
| Ovary | oophor- |
| Lung | pneum- |
| Fallopian Tubes | salping- |
| Mouth | stomat- |
| Anterior, ventral | Front surface of the body |
| Posterior, dorsal | Back side of the body |
| Superior | Above another structure |
| Inferior | Below another structure |
| Proximal | Near midline of trunk |
| Distal | Far from midline of trunk |
| Medial | Middle of body |
| Lateral | Side of body |
| Frontal, coronal | Vertical plane dividing body into front and back |
| Sagittal | Vertical plane dividing body into right and left |
| Transverse | Horizontal plane dividing body into upper and lowere |
| Integumentary System | Skin and accessory organs |
| Three layers of the skin | Epidermis, Dermis, Subcutaneous |
| Keratin | Protein found in hair fibers |
| Lunula | White area at the base of the nail |
| Eponychium | Cuticle |
| Sebaceous Gland | Secrete and oily substance called sebum |
| Sebum | Helps lubricate skin |
| Two Sweat Glands | Eccrine and Apocrine |
| Adrenal Glands | Secrete hormones called epinephrine and steroids |
| Albino | Deficient pigment |
| Melanin | Skin pigment |
| Callogen | Structural protein found in the skin and connective tissue |
| Lipcyte | Fat cells |
| Macule | Discolored flat lesion (freckle) |
| Polyp | Benign growth extending from surface of mucous membrane |
| Fissure | Cracklike sore |
| Nodule | Solid, round, elevated lesion. More than 1 cm in diameter |
| Ulcer | Open sore on skin or mucous membrane |
| Vesicle | Small collection of clear fluid (blister) |
| Wheal | Smooth, slightly elevated, swollen area that is redder than surrounding sin |
| Alopecia | Absence of hair where it normally grows |
| Gangrene | Death of tissue associated with loss of blood supply |
| Impetigo | Bacterial inflammatory skin disease |
| Multigravida | Pregnant woman who has had at least one previous pregnancy |
| Musculoskeletal System | Includes bones, muscles, and joints |
| Ligaments | A fibrous muscular band that connects bones |
| Osseous | Connective tissue that makes up bones |
| Hematopoietic Tissue | Inner core of bones where red bone marrow manufactures blood cells |
| Axial Skeleton | Skull, rib cage, and spine |
| Appendicular Skeleton | Shoulder, collar, pelvic, arms, and legs |
| Long bones | Very strong, large surface for muscle attachment (humerus and femur) |
| Short bones | Small with irregular shapes (wrist and ankle) |
| Flat bones | Covers soft parts of body (shoulder blades, ribs, and pelvic bones) |
| Sesamoid bones | Small rounded bones found near joints (kneecap) |
| Frontal bones | Forms anterior part of skull and forehead |
| Parietal bones | Forms side of cranium |
| Occipital bones | Forms the back of skull |
| Temporal bones | Forms two lower sides of cranium |
| Ethmoid Bones | Forms the roof of the nasal cavity |
| Sphenoid Bones | Anterior to the temporal bone |
| Zygoma | Cheek bone |
| Lacrimal bone | Bones at the corner each eye that cradle tears ducts |
| Maxilla | Upper jaw bone |
| Mandible | Lower jaw bone |
| Vomer | Posterior inferior part of the nasal septal wall between the nostrils |
| Palatine bones | Make up part of the roof of the mouth |
| Inferior nasal conchae | Make up part of the interior of the nose |
| Cervical | Neck bones |
| Thoracic | Upper back |
| Lumbar | Lower back |
| Sacral | Sacrum |
| Coccygeal | Coccyx (tailbone) |
| Rib cage | 12 pairs of ribs |
| True ribs | First 7 attached directly to the sternum |
| False ribs | Ribs 8, 9, and 10 attached to the sternum by cartilage |
| Floating ribs | Last 2 ribs that are not attached at all |
| Scapula | Shoulder blades |
| Clavicle | Collar bone |
| Humerus | Upper arm bone |
| Ulna | Lower medial arm bone |
| Radius | Lower lateral arm bone in line with the thumb |
| Carpals | Wrist bones |
| Metacarpals | Fingers and bones in the palm of the hand |
| Phalanges | Finger bones |
| Pelvis | Superior and widest bone |
| Ischium | Lower portion of pelvic bone |
| Pubic bone | Lower anterior part of bone |
| Femur | Thigh bone |
| Patella | Kneecap |
| Tibia | Shin |
| Fibula | Smaller lateral leg bone |
| Malleolus | Ankle |
| Tarsal | Hind foot bone |
| Metatarsal | Midfoot bone |
| Phalanx | Toe bone |
| No ROM (Range of motion) | Immoveable joints held together by fibrous tissue |
| Limited ROM | Joints joined together by cartilage that is slightly moveable |
| Full ROM | Joints that have free movement |
| Extension | Increase angle of a joint |
| Flexion | Decrease angle of a joint |
| Abduction | Movement away from the midline |
| Adduction | Movement towards the midline |
| Supination | Turning the palm or foot upward |
| Pronation | Turning palm or foot downward |
| Dorsiflexion | Raising foot and pulling toes towards the shin. |
| Plantar Flexion | Lowering foot and pointing toes away from shin |
| Eversion | Turning outward |
| Inversion | Turning inward |
| Protraction | Moving part of body forward |
| Retraction | Moving part of body backward |
| Rotation | Revolving bone around its axis |
| Comminuted | The bone is crushed and/or shattered |
| Compression | Fractured bone collapses on itself |
| Colles | Break of distal end of radius at the epiphysis often occurs when the patient has attempted to break their fall. |
| Complicated | When a broken bone pierces an internal organ |
| Impacted | When broken bones are driven into each other |
| Hairline | A minor fracture as a thin line and may not extend completely through bone |
| Greenstick | Bone is partially bent and broken; common in children because of soft bones |
| Pathologic | Any fracture occurring spontaneously as a result of disease |
| Salter-Harris | A fracture of the epiphyseal plate in children |
| Sprain | Traumatic injury to join involving soft tissue |
| Soft tissue | Muscles, ligaments, and tendons |
| Strain | A lesser injury resulting from overuse or overstretching |
| Dislocation | When a bone is completely out of place |
| Subluxation | Bone partially out of joint |
| E/M Section | Includes codes that pertain to the nature of physicans' work;depends on type of service, patient status, and place of service. Divided into broad categories (office and hospital visits and consultations) |
| Established patient | Receives services within last three years |
| ICD-9-CM | International Classification of Diseases, 9th Revision,Clinical Modification |
| Three volumes of ICD manual | Volume 1: Diseases in Tabular List Volume 2: Disease: Alphabetic Index Volume 3: Procedures, Tabular List and Alphabetic Index |
| Supplementary Classification of Factors Influencing Health Status and Contact with Health Services | V Codes |
| V Codes | Identify that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems.(Found in Vol. 1 and 2) |
| Supplementary Classification of External Causes of Injury and Poisoning | E Codes |
| E Codes | Classify environmental events, circumstances, and conditions as the cause of injury, poisoning, and other adverse effects and captures of injury/poisoning happened, the intent,and the place where the event happened. |
| Tabular List Volume 1 | 001-999 Consists of 17 chapters based on either body system or cause or type of disease. |
| Chapters | Main division in ICD-9-CM. Divided into sections |
| Sections | Composed of a group of three digit categories representing a group of conditions or related conditions. Divided into categories. |
| Categories | Composed of three digit codes representing a single disease or condition. Only used if code is not further subdivided. Most require a fourth digit. |
| Subcategories | Provides a fourth digit code(in terms of cause, sight, or manifestation of condition)Must be used if available. |
| Subclassification | Provides a fifth digit code which gives the highest specificity of description of condition. Must be used if available. |
| Alphabetic Index Volume 2 | The main term in the index may be followed by terms in parenthesis which are called nonessential modifiers because their presence or absence do not have an effect on the selection of the code list for the main term. |
| Subterms | Terms indented 2 spaces to the right below the main term. They're essential modifiers. |
| Hypertension Table | Found in the index under the main term "hypertension." Contains a list of conditions that are due to or associated with hypertension. |
| Hypertension Table Malignant | An accelerated severe form of hypertension with vascular damage and a diastolic pressure of 130 mmHg or greater. |
| Hypertension Table Benign | Mild or controlled hypertension and no damage to the vascular system or organs. |
| Hypertension Table Unspecified | Not specified as benign or malignant in the diagnosis or medical record. |
| Neoplasm Table | Located in the index under the main term "neoplasm" and is organized by anatomic sight |
| Neoplasm Malignant | Further classified as primary, secondary, or carcinoma in situ |
| Neoplasm Table Primary Malignancy | Original cancer site. Malignant tumors considered primary unless documented as secondary or metastatic |
| Neoplasm Table Secondary Malignancy | Cancer that has metastasized to a secondary site,either adjacent or remote region of the body. |
| Neoplasm Table Carcinoma In Situ | Cancer that is localized and has not spread to adjacent tissues or distant parts of body. |
| Neoplasm Table Benign | Noninvasive, non-spreading, and nonmalignant |
| Neoplasm Table Uncertain Behavior | Uncertain whether benign or malignant; borderline malignancy. |
| Neoplasm Table Unspecified Nature | Neoplasm as identified however no nature of tumor is documented in the diagnosis or medical record. |
| Alphabetic Index | Contains three sections |
| Alphabetic Index Section 1 | Index to Diseases: each term is followed by code(s) that apply to that term. |
| Alphabetic Index Section 2 | Table of Drugs and Chemicals: contains a list of drugs and chemicals with the corresponding poisoning codes and E codes. The E codes are used to explain circumstance surrounding poisoning. |
| Alphabetic Index Section 3 | Index to External Causes of Injury (E Codes): Classifies in alphabetical order environmental events and other conditions as the cause of injury and other adverse effects. |
| Health Care Financing Administration Common Procedure Coding System | HCPCS reference manual |
| National Provider Identifier (NPI) | CMS assigns a standard unique identifier |
| Healthcare Common Procedure Coding System (HCPCS) | CMS created this collection of codes for procedures, supplies, products, and services that may be provided to Medicare and Medicaid beneficiaries and those enrolled in private health insurance programs |
| HCPCS Level I codes | Consist of codes found in CPT manual. They are five position numeric codes used to report physician services rendered to patients |
| HCPCS Level II codes (National Codes) | Contains five position alpha-numeric codes for physician and non-physician services not found in the CPT (level I)HCPS |
| HCPCS Level II codes | Start with a letter followed by 4 numbers. Covers supplies, materials, or injections that are covered by Medicare. Some codes are for physician and non-physician services not found in CPT manual. |
| Current Procedural Terminology (CPT) | Used to report services and procedures by physicians. Published and updated annually by American Medical Association (AMA) |
| CPT Category I Codes | Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved the the FDA |
| CPT Category II Codes | Supplemental codes used for performance measurements |
| CPT Category III Codes | Temporary codes for emerging technology, services and procedures. If category III code is available, it is reported rather than a category I unlisted code |
| Eight sections of CPT manual | Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine, Category II Codes, and Category III Codes |
| Stand-alone codes | Contain the full description of the procedure for the code |
| Indented codes | Codes listed under associated stand-alone codes. To complete the description refer to the portion of the stand-alone description before the semi-colon |
| Modifiers | Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code |
| CPT manual uses | Five-digit numeric system for coding services rendered by physicians |
| Triangle ▲ | Represents a change in the code description |
| Two triangular symbols ► ◄ | Represents a change in the text or definition between the triangles |
| Bullet ● | Represents a new procedure or service code added since the previous edition of the manual |
| Plus sign + | Indicates add-on codes |
| Circle with a line through it ϴ | Represents exemption from modifier -51 |
| Evaluation and Management | 99201-99499 |
| Anesthesia | 00100-01999, 99100-99140 |
| Surgery | 10021-69990 |
| Radiology | 77010-79999 |
| Pathology and Laboratory | 80048-89356 |
| Medicine | 90281-99199, 99500-99602 |
| Add-on Codes | Addition to primary procedure performed. Apply only to procedures performed by the same physician to describe additional intra-service work provided. Never used alone and always reported in addition to primary procedure. Exempt from modifier -51 |
| Location Methods | 1. Service or procedure 2. Anatomic site 3. Condition or disease 4. Synonym/Eponym 5. Abberviation |
| CPT Modifiers | Two-digit add-ons attached to regular codes in circumstances where procedures were altered |
| -24 | Unrelated E/M Service by the Same Physician During a Postoperative Period |
| -26 | Professional Component |
| -32 | Mandated Services |
| -50 | Bilateral Procedure |
| -51 | Multiple Procedures |
| -58 | Staged or Related Procedure or Service by the Same Physician during Postoperative Period |
| -78 | Return to the Operating Room for a Related Procedure During the Postoperative Period |
| -79 | Unrelated Procedure or Service by the Same Physician During the Postoperative Period |
| -90 | Reference (Outside) Laboratory |
| -99 | Multiple Modifiers |
| E/M Codes | Cover physician's services that are performed to determine the best course for patient care |
| Key components of E/M | -History: Chief complaint; History of present illness; Review of systems; Past, family, and social history -Physical Examination -Medical decision making |
| Unlisted Procedures | Procedures considered experimental, newly approved, or seldom used. Located at the end of the subsections or subheadings |
| Surgical Package, also called "global surgery" | -Surgical procedure performed -Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia -Preoperative E/M services -Immediate postoperative care -Normal, uncomplicated postoperative care |
| Policyholder | One who purchases the contract |
| Insurance carrier | One who provides the benefits plan |
| Group Insurance | When a group of employees and their dependents are insured under one policy issued to the employer |
| Personal Insurance | An insurance plan issued to an individual |
| Pre-paid Health Plan | Pre-determined set of benefits covered under one set annual fee |
| Indemnity Insurance | Fee-for-service. Services are paid for that are listed in the policy and payments are based on the fees physicians charge for service |
| Managed Care Plan | Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point-of-Service Plan (POS), and Preferred Provider Plan |
| HMO | Provides a wide range of medical services to individuals that have been enrolled into the program |
| PPO | Similiar to HMO but charges higher premiums in exchange for more flexibility and more options |
| POS | Gives beneficiaries the option whom to see for service |
| Preferred Provider Plan | May see provider outside of plan but is responsible to pay the higher protion of the fee |
| The Usual, Customary, and Reasonable | Usual- The physician's most frequent charge fora given service Customary- Average charge of all providers of similar training and experience Reasonable- Actual charge submitted on a claim |
| Relative Value Payment Schedules Method | Uses relative value scales to assign a relative weight to individual services according to the basis for the scale |
| Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule | Relative value is the sum of work: represents amount if time, effort and medical skill required of physician Overhead: practice costs related to procedure Malpractice: cost of medical malpractice insurance |
| How RBRVS payments are determined | By multiplying a code's relative value by a constant dollar amount called the conversion factor |
| The St. Anothony Relative Value for Physician (RVP) | Has no geographic adjustment (unlike RBRVS). For each category of procedures a separate conversion factor must be developed |
| Contracted Rates with MCOs | Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients |
| Capitated Rates | Physician provides a full range of contracted services to covered patients fora fixed amount on a periodic basis |
| Medicare | Federal government program created by the Social Security Act of 1965 administered by CMS formally HCFA |
| Medicare is available to | -65 and older on Social Security benefits -Spouse of a person paying Social Security -Persons who receive benefits after 24 months -Diagnosed with end-stage renal disease (ERSD) -Kidney donors to ERSD -Retired federal employees of the CSRS |
| Medicare Health Insurance Claim Numbers (HCINs) | Issued by CMS, are usually Social Security numbers with letter or letter/number suffixes. |
| Medicare Part A | Inpatient, hospice, and home health services |
| Medicare Part B | Supplement to Part A which covers medical expenses, clinical laboratory services, home health care, outpatient hospital treatment, blood, and ambulatory services |
| Medicare Part C | Medicare Managed Care Plans offers healthcare services in addition to A and B |
| Medicare Part D | Prescription drugs |
| Medicare Claim Status | Clean claim, dirty claim, invalid claim, and rejected claim |
| Clean Claim | Accurately filled out |
| Dirty Claim | Contains errors or omissions |
| Invalid Claim | Contains complete necessary information but is incorrect or illogical |
| Rejected Claim | Requires investigation and needs further clarification |
| Advanced Beneficiary Notice | Document provided to a Medicare beneficiary by a provider prior to service letting them know of their responsibility to pay if Medicare denies the claim |
| Medigap (Medicare Supplemental Insurance) | To pay for service and items Medicare does not cover |
| Medicaid | Federal program provides medical assistance to the needy. Varies state to state. |
| Eligibility for Medicaid: Categorically Needy | -Families, pregnant woman, and children -Aged and disabled persons -Persons receiving institutional or other long-term care in nursing facilities and immediate care facilities |
| Eligibility for Medicaid: Medically Needy | -Medically indigent low-income individuals and families -Low-income persons losing employer health insurance coverage |
| Coverage with Medicare and Medicaid | Medicaid usually pays the Medicare Part B deductibles, coinsurance, and monthly premium amounts |
| Workers Compensation | State-required insurance plan. Provides benefits to employees and their dependents for work related injury, illness, or death |
| Five Types of Workers Comp. | -Medical treatment -Temporary disability -Permanent disability -Vocational rehabilitation -Death benefits for survivors |
| Disability Insurance | Reimbursement for income loss as a result of a temporary or permanent illness or injury |
| Liability Insurance | Covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured |
| TRICARE | Regionally managed healthcare program for active duty and retired members or the armed forces, their families, and survivors. |
| Three types of plans covered under TRICARE | 1. Standard: fee-for-service, cost-sharing plan 2. Extra: preferred provider organization 3. Prime: HMO plan with a point-of-service option |
| CHAMPVA (Civilian Health and Medical Program of the Veteran Affairs) | Provides medical benefits to spouses and children of veterans with total, permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service related disability |
| Commercial Carriers | For profit organizations that operate in the private sector selling different health insurance benefit plans to groups or individuals (Aetna, Cigna, Travellers, and Prudential) |
| Blue Cross/Blue Shield Plans | Contract with physicians and other health entities to provide services to insured companies and individuals |
| Blue Cross | Covers hospital services, outpatient care, some institutional services, and home care |
| Blue Shield | Covers physician services, and in some cases dental, outpatient services, and vision care |
| Paper Claim | CMS-1500 |
| Electronic Claim | Submitted directly by the physician or through a clearinghouse and are usually paid faster |
| Clearinghouse | Entity that receives transmissions from physicians' offices, separates the claims by carriers and performs software edits on each claim to check for errors. Claim is then sent to proper insurance carrier and result is sent back to the claims preparer |
| Universal Claim Form | Blocks 1-13 refers to patient information Blocks 14-33 refers to physician information |
| I. Life Cycle of an Insurance Claim: Claim Submission | Transmission of claim's data electronically or manually to third party payers or clearinghouses for processing |
| IV. Life Cycle of an Insurance Claim: Non-covered Benefit | Procedure or service reported on insurance claim that is not listed in payer's master benefits list. Results in denied claim |
| V. Life Cycle of an Insurance Claim: Unauthorized Benefit | Procedure or service provided without proper authorization. Results in denied claim |
| VI. Life Cycle of an Insurance Claim: Payment | Once claim is approved for payment, a remittance advice is sent to provider and an EOB is mailed to policy holder |
| II. Life Cycle of an Insurance Claim: Claim Processing | Third party payers and clearinghouses verify information found in a submitted claim |
| III. Life Cycle of an Insurance Claim: Claim Ajudication | Claim is compared to payer edits and the patient's health plan benefits to verify information |
| Assignment of benefits | Reimbursement is directly sent from the payer to the provider |
| Accept Assignment | Provider agrees to accept what the insurance company approves as payment in full for the claim |
| Inpatient vs. Outpatient | Inpatient- patient is admitted 24 hours or more Outpatient- patient is released within 23 hours |
| Consultation | Service provided by physician whose opinion or advice is requested by another physician for evaluation or treatment of a patient's problem |
| Fee Schedule | List of charges or allowances that have been accepted for specific medical services |
| Fee-for-service | Fee that is charged for each procedure/service performed by the physician |
| Fiscal Intermediary | An insurance company that bids for a contract with CMS to handle the Medicare program in a specific area |
| Premium | Cost of insurance coverage paid annually, semiannually, or monthly to keep a policy in effect |
| Deductible | Accumulative out of pocket amount that must be paid annually by a policy holder before benefits will be paid by insurance company |
| Coinsurance | Percentage of the cost of covered services that a policyholder pays. Common percentage is 80/20 |
| Medical Necessity | The determination that a service or procedure rendered is reasonable and necessary for thee diagnosis or treatment of an illness or injury |
| Precertification | Determines coverage for a specific treatment under the insursed's policy |
| Predetermination | To determine the patients benefits and the maximum dollar amount that the insurance company will pay |
| Preauthorization | Requirement for some health insurance plans to obtain permission for a service or procedure before it is done |
| Eligibility | Qualifying factors that must be met before a patient receives benefits |
| Coordination of benefits | When two insurance companies work together to coordinate payment of the benefit |
| Encounter Form | Also known as "superbill". Listing of the diagnoses, procedures, and charges for a patients visit |
| Itemized Statement | A statement of patients account history showing dates of service, detailed charges, payments, the date the insurance claim was submitted, adjustments, and account balance |
| Civil Monetary Penalties Law (CMPL) | Law to prosecute cases of Medicare fraud |
| Good Samaritan Act | Developed to protect health care professionals from liability of any civil damages as a result of rendering emergency care |
| Remittance Advice | Report of payment sent by the payer to the provider |
| The Patient Care Partnership (Patient's Bill of Rights) | Developed to promote the interest and well-being of the patients of the health care facility |
| Physicians' State Licence Number | Number that must be obtained in order to practice within a state |
| Employer Identification Number (EIN) | Federal tax identification number |
| Provider Identification Number (PIN) | Number assigned by insurance company to a physician who renders services to patients |
| Group Provider Number | Number used for provider whose is a member of a group practice |
| Preforming Provider Identification Number (PPIN) | Separate number for each group office/clinic in which they practice |
| Participating Physician | Contract with a health insurance plan and accepts whatever the plan pays for procedures and services rendered |
| Non-participating Physician | Has no contract with the health insurance plan |
Created by:
crystalhanson