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4020 term


abn advance beneficiary notice
cms centers for medicare and medicaid services
ssi social, security income
hcfa health care financing administration
cms-1500 center for medicare & medicaid services health ins claim form
esrd end stage renal disease
mma medicare prescription drug improvement & modernization act
mg medigap
eob explanation of benefits
cci correct coding initiative
rbrvs resource based relative value scale
rvu relative vale unit
pqri physician quality reporting initiative
lcd local coverage decision
lcd local coverage decision
sof signature on file
ra remittance advice
era electronic remittance advice
advance beneficiary notice an agreement given to the pt to read and sign before rendering a service that maybe denied or paid.
assignment an agreement signed by the pt that assigns the right to receive payment for the services from the insurance
correct coding initiative federal legislation that attempt to eliminate unbundleing or other inappropriate reporting of procedural codes for professional medical services rendered to patients
crossover claim a claim automatically sent electronically to the secondary payer when a person has both primary and secondary insurance
hospice a public agency or private organization that is primarily engaged in providing pain relief, symptom management & supportive service to terminally ill people & their families.
respite care a short term inpatient stay
medical necessity performance of service & procedures that are consistent with diagnosis
medicare part A hospital coverage, no charge
medicare part b out patient coverage
medi/medi medicare medicaid
remittance advice a document detailing services billed & describing payment determination issued to providers
medicare secondary payer the primary insurance plan of a medicare beneficiary that must pay for any medical care or service first before medicare is sent a claim
whistle blowers informants who report physicians suspected of defrauding the federal government
Established patient an individual who has received professional services with in the past 3 years
new patient an individual who has NOT received any professional services from the physician or another physician who belongs to the same group practice within the past 3years
review of systems an inventory of body systems related to chief complaint
key elements history, physical examination medical decision making are the individualized steps in the identification of the correct e& m procedure code for services performed
initial visit the first visit during an episode of care.
subsequent visit after the initial visit during an episode of care
medicare a federal health insurance program for 65plus, retired from railroad, disabled individuals, & all ages with end stage renal disease.
Created by: deefuerte