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4020 term
terminology
| Question | Answer |
|---|---|
| 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
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