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Stack #598708
Terminology Mod 150, Unit 1
| Question | Answer |
|---|---|
| ALJ | administrative law judge |
| Appeal | A request for review of an insurance claim that has been underpaid or denied by an insurance company to receive additional payment |
| CMS | Center for Medicare and Medicaid Services |
| DAB | Departmental Appeal Board |
| Delinquent claim | an insurance claim submitted to an insurance company, for which payment is overdue |
| Denied paper or electronic claim | an insurance claim submitted to an insurance company which payment has been rejected owing to a technical error or because of medical coverage policy issues |
| ERISA | Employee Retirement Income Security Act |
| Explanation of Benefits (EOB) | A document detailing services billed and describing payment determinations; also known in Medicare, Medicaid, and some other programs as a remittance advice |
| FTC | Federal Trade Commission |
| HCPCS | Healthcare Common Procedure Coding System |
| HIPAA | Health Insurance Portability and Accountability |
| HMO | health maintenance organization |
| HO | hearing officer |
| Inquiry | Tracer; an inquiry made to an insurance company to locate the status of an insurance claim |
| Lost claim | an insurance claim that cannot be located after sending it to insurer |
| Medigap(MG) | A specialized supplemental insurance policy devised for Medicare beneficiary that covers the deductible and copayment amounts typically not covered under the main Medicare policy written by a nongovernmental third-party payer |
| NPI | National Provider Identifier |
| Overpayment | Money paid over and above the amount due by the insurer or patient |
| Peer review | the review of a patients case by one and more physicians using federal guidelines to evaluate another physician in regard to the quality and efficiency of medical care |
| Rebill (resubmit) | to send another request for payment for an overdue bill to either the insurance company or patient |
| Rejected claim | an insurance carrier that is discarded by the system because of a technical error or because it does not follow Medicare instructions |
| Remittance advice (RA) | A document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program |
| Review | to look over a claim to access how much payment should be made |
| Suspended claim | an insurance claim that is processed by the insurance carrier but held in an indeterminate (pending) state about payment either because of an error or the need for additional information |
| Tickler file | an alternative manual method used to track pending or resubmitted insurance claims |
| TRICARE | A three-option managed health care program offered to spouses and dependents of service personal with uniform benefits and fees implemented nationwide by the federal government |
| UPIN | Unique Provider Identification Number |
| Aging reports | each month a report should be run that will indicate which claims are outstanding |
| Ambi- | both, both sides, around, about |
| Bi- | two, double |
| Circum- | around |
| Deca- | ten |
| Infer- | below |
| Inter- | between |
| Intra- | within |
| Nulli- | none |
| Poly- | many, much, excessive |
| Super- | upper, above |
| -algesia | condition of pain |
| -blast | immature cell, germ cell |
| -cyst | bladder, sac |
| -graphy | recording |
| -lepsy | seizure |
| -lysis | destruction, separation -ectomy |
| -genesis | formation, produce |
| -orexia | appetite |
| -rrhage | to burst forth bursting forth |
| -rrhaphy | suture |
| -rrhexis | rupture |
Created by:
BLONDIEHXAA
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