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CODING CHAPTER 1
INTRO
| Term | Definition |
|---|---|
| PHI | Patient info: demographics, identifying information, diagnoses, etc. |
| OIG | Identifies and combats waste, fraud, and abuse. Develops work plan to identify areas of focus for the upcoming year. |
| HIPAA | Law that protects patient privacy - Portability and Accountability Act |
| HMO | Type of insurance plan - select PCP, must stay in network, need referral for specialist visit |
| EPO | Type of insurance plan - no need to select PCP, must stay in network, no referral for specialist visit |
| PPO | Type of insurance plan - no need to select PCP, not required to stay in network, no referral necessary |
| Federal Register | Publication for rules, proposed rules, and notices of the Federal Government |
| CMS | Centers for Medicare and Medicaid Services - website includes manuals and guidelines for billing |
| MAC | Private health care insurer that processes Medicare claims - MACS vary by geographic location. |
| RVU | Value assigned to each code which represents cost for providing service. |
| Three components that make up RVU | Work involved, practice expenses (rent, etc.), and malpractice insurance. |
| Conversion Factor (CF) | Dollar multiplier that converts the RVU into an actual dollar amount. |
| GPCI (Geographic Practice Cost Indices | Accounts for differences in the cost of practice across the country according to location. |
| Medicare Part A | Hospital coverage |
| Medicare Part B | Supplementary coverage (office visits, etc) |
| Medicare Part D | Prescription drug coverage |
| Medicare Part C | Medicare Advantage Organizations (beneficiaries choose their providers & type of coverage) |
| CPT Book | Includes codes for all types of physician services - procedures, office visits, lab work, radiology, etc. |
| ICD-10 | Includes diagnosis codes |
| EMR | Electronic Medical Record |
| Fraud | The intentional deception or misrepresentation of information in order to receive unauthorized benefit |
| OBRA | Includes provisions establishing physician fee schedule, standard rates for increases, etc. |
| Medical Necessity | The reason for receiving medical services |
Created by:
kducey
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