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CBCS: Module 4 Vocab
| Term | Definition |
|---|---|
| 835 | Electronic Transmission of RA/EOB information |
| 837P | The electronic version of a professional claim form |
| Aging Report | A report that shows the length of outstanding balances in the system |
| Appeal | The official process of requesting a review of a claim that was underpaid or benied |
| Claim Editing | A step in the claims process in which appropriate codes and rules are verified before the claim is submitted |
| Electronic Funds Transferred (EFT) | The computer-based transfer of money. In the context of medical billing, it usually refers to an organization receiving reimbursement from a third-party payer |
| Local Coverage Determination (LCD) | Describes coverage determined by a MAC about a particular service |
| Medicare Administrative Contractor (MAC) | A third-party payer that has been contracted to process Medicare Part A and Part B medical claims for Medicare Fee-For-Service (FFS) beneficiaries |
| National Correct Coding Initiative (NCCI) | This imitative provides a code editing system that prevents inappropriate reporting of CPT codes |
| National Coverage Determination (NCD) | Describes Medicare coverage for a specific service procedure or device |
| National Uniform Claim Committee (NUCC) | National Uniform Claim Committee- This committee provides guidelines for each block of the CMS-1500 form |
| Payer mix | The showing of a percentage of usage under a specific payer |
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