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4020
week 1 terms
| Question | Answer |
|---|---|
| ABN | advance beneficiary notice |
| MMA | medicare prescription improvement & modernization act |
| CMS | centers for medicare and medicaid services |
| SOF | signature on file |
| SSI | social security income |
| HCFA | health care financing administration |
| CMS-1500 | centers for medicare and medicaid services health insurance claim form |
| RBRVS | resource based relative value scale |
| RVU | relative value unit |
| RA | remittance advice |
| MG | medigap |
| ERA | electronic remittance advice |
| PDP | private prescription drug plan |
| EOB | explaniation of benefits |
| CCI | correct coding initiative |
| ESRD | end stage renal disease |
| LCD | local coverage decisions |
| advanced beneficiary notice | an agreement given to the patient to read and sign before rendering a service that maybe denied or paid |
| assignment | an agreement signed by the patient that assigns the right to recieve payment for the services from the insurance |
| correct coding initiative | federal legislation that attempts to eliminate unbundling or other inappropriate reporting of procedure codes for professional medical services rendered to patients |
| crossover claim | a calim automatically sent electronically to the secondary payer when a person has both primary and secondary insurances |
| hospice | a public agency or private organization primarily engaged in providing pain relief symptom management or terminally ill and their families |
| respite care | short term inpatient stay for a terminally ill patient to give temporary relief |
| medical necessity | the performance of services and procedures that is consistant with the diagnosis |
| medicare part a | hospital coverage no charge |
| medicare part b | outpatient coverage |
| medi-medi | individual who recieves medicaid and medicare simutaneously |
| remittance advice | document detailing services billed and describing payment determination issued to providers |
| medicare secondary payer | primary insurance plan of medicare beneficiary that must pay for any medicare or services first before medicare is sent a claim |
| whistleblowers | suspected or defrauding the federal government |
| established patient | individual who has recieved professional care within the past 3 years from the physician or another physician in the same group practice |
| new patient | individual who has not recieved any professional care within the past 3 years from the physicain or another physcian in the same group practice |
| review of systems | inventory of systems related to the chief complaint |
| key elements | history physical examination medical decision making are the individualized steps in the identification of the correct e/m procedure codes for services performed |
| initial visit | first visit during an episode of care |
| subsequent visit | visits after the initial or first visit of an episode of care |
| medicare | a federal health insurance program for people over 65 or certain disabled/blind people or renal disease regardless of income |
Created by:
secretsluv
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