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Mode 4020

4020Terms and Abbreviations

QuestionAnswer
Advanced Beneficiary Notice an agreement given to the patient to read and sign before rendering a service that may be denied for payment.
Assignment an agreement signed by the patient assigns the right to receive payment for the services from the insurance.
Correct Coding Initiative Federal legislation that attempts to eliminate unbundling or other inappropriate reporting of procedural codes for professional medical services rendered to patients.
Crossover claim The claim is automatically transferred sent electronically to the secondary payer when a person has both a primary and secondary insurance.
Hospice A public agency or private organization primarily engaged in providing pain relief, symptom management, and support services to terminally ill patients and their families
Respite Care is short term inpatient stay that may be necessary for terminally ill patients to give temporary relief to the person who regularly assists with home care.
Medical Necessity Performance of service and procedures consistent with the diagnosis in accordance with standards of good medical practice performed at proper level and provided in the most appropriate setting.
Medicare Part A Hospital benefits of a nationwide health insurance program for persons age 65 years of age and older and certain disabled individuals regardless of income, administered by CMS.
Medicare Part B Outpatient coverage-- medical insurance of nationwide health insurance program for person 65 years of age and older and certain disabled individuals regardless of income, administered by CMS.
Medi-Medi refers to an individual who has both Medicaid and Medicare benefits.
Remittance Advice a document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program; also known ins some programs as an explanation of benefits.
Medicare Secondary Payer (MSP) Medicare is considered secondary, the primary insurance must be billed first and the Medicare second, with a copy of the EOB.
Whistleblowers informants who report physicians suspected of defrauding the federal government.
Established Patient an individual who has received professional services within the past 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
New Patient an individual who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.
Review of Systems an inventory of body systems obtained through a series of questions used to identify signs or symptoms that the patient might be experiencing or has experienced. Inventory of systems related to the chief complaint.
Key Elements individualized steps in the identification of the correct E & M procedure codes for the services provided.
Initial Visit the initial or first, visit during an episode of care.
Subsequent Visit visits after the initial, or fist, visit during an episode of care.
Medicare a federal nationwide health insurance program for persons age 65 years of age and older and certain disabled or blind persons regardless of income and those with ESRD.
Created by: SSchabow