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physician office billing CH

fixed prepayment to medical provider for all necessary services provided to a plan member patient(Pt) capitaiton
payment made after the Pt receives services retroactive payment
amount that the insured pays on covered services before benefits begin deductible
a percentage of each claim that the insured pays coinsurance
plan in which members can visit any specialists in their network w/o a referral from their PCP PPO
controlled drug costs from a list of selected pharmaceuticals as determined by an HMO formulary
failure to perform medical duties properly negligence
face to cace meeting with a Pt encounter
concise statement that describes symptoms, problem condition or diagnosis that Pt gives during encounter chief complaint
electronic format used to verify benefits HIPPA eligibility for Health Plan
the most a payer will pay any provider for that work allowed charge
employers that offer health plans to employees w/o using third-party insurance carriers self-funded health plan
total amount that will be paid for a covered persons covered expenses during their lifetime maximum benefit limit
ten-digit number for the insurance policyholder or guarantor taxonomy code
3 government-sponsored health care programs medicare - medicaid - tricare
an example of a secondary provider identifier would be what? the physicians EIN number
violating the HIPPA Privacy Rule can result in what both civil and criminal penalties
medicare typically pays for what percentage of allowed charges 50, 60, 70 or 80% 80%
how many diagnosis code pointers can be assigned to a procedure code? 4
the NPI is used to report what on a claim provider identifier
a system used to encode elements of data code set
downcoding means billing at a lower level code than what was proformed
what type of coding uses diagnoses that are not coded to the highest level truncated coding
the physician who actually provided the service is called what rendering provider
CMS stands for centers for medicare and medicaid services
PCP primary care provider
EDI eletronic data interchange
EHR eletronic health records
PMP practic management program
Created by: cpar