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CMS-1500 Claim
Essential Claim Instructions
| Term | Definition |
|---|---|
| billing entity | legal business name of the provider's practice |
| diagnosis pointer | used to describe relationships between submitted diagnosis and service line treatment information on health claims and encounters. They indicate the reason the service was performed. |
| National Plan and Provider Enumeration System (NPPES) | developed by CMS to assign unique identifiers to health care providers (NPI) and health plans (HPID) |
| optical character reader (OCR) | device used for optical character recognition |
| optical scanning | uses a device (e.g. scanner) to convert printed or hand written characters into text that can be viewed by an optical character reader. |
| supervising physician | a licensed physician in good standing who, according to state regulations, engages in the direct supervision of nurse practitioners and/or physician assistants whose duties are encompassed by the supervising physician's scope of practice. |
| supplemental plan | covers the deductible and copay or coinsurance of a primary health insurance policy |
| National Provider Identifier (NPI) | unique identifier to be assigned to health care providers as an 8- or possibly 10-character alphanumeric identifier, including a check digit in the last position. |
| check digit | one-digit character, alphabetic or numeric, used to verify the validity of a unique identfier |
| global fee (global surgery package) | charges are bundled into one charge covering presurgical evaluation and management, initial and subsequent hospital visits, surgical procedure, the discharge visit, and uncomplicated postoperative follow-up care in surgical office. |
| direct admission | physician refers a patient to the hospital for observation, bypassing the clinic or emergency department |
| preoperative | before surgery |
| postoperative | after surgery |
| observation services | clinically appropriate services including; ongoing short-term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged. |
Created by:
tina.reynolds
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