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4030 wk3

def bbv

QuestionAnswer
ABN ADVANCE BENEFICIARY NOTICE
EOB EXPLANATION OF BENEFITS
UCR USUAL CUSTOMARY REASONABLE
RBRVS RESOURCE-BASED RELATIVE VALUE
E & M EVALUATION AND MANAGEMENT
Rt RIGHT
Lt LEFT
HTN HYPERTENSION
FI FISCAL INTERMEDIATE
Diag DIAGNOSIS
UTI URINARY TRACT INFECTION
OIG OFFICE OF THE INSPECTOR GENERAL
HIPAA HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT
CMS CENTERS FOR MEDICARE AND MEDICAID SERVICES
S/P STATUS POST
ADVANCED BENEFICIARY NOTICE a form stating that the service may not be covered must be signed in advanced before service is done
CHARGE TICKET a document used by the practice to aid in insuring that correct codes are being used for billing and coding
OFFICE OF THE INSPECTOR GENERAL has the authority to suspend exclude terminate and impose fines and penalties on providers, practitioners that commit fraud
FALSE CLAIMS ACT a federal law that allow people not affiliated w/ the gov. to report fowl actions against federal contractor claiming fraud against the government fna the whislebloweres act
FRAUD an intentional misrepersentation of the facts to deceive or mislead
ABUSE incidents or practices, not usually considered fraudulent, that are inconsistent w/ accepted sound medical buniness or fical practices
JOINT COMMISSION ON THE ACCREDITATION OF THE HOSPITAL ORGANIZATION requirements for reimbursment by a third-party carrier validates by quality of care and provide a competitive edge over facility that are not a credit.
WHISTLE BLOWERS PROTECTION ACT ropart physicans suspected of defrauding the federal gov.
QUI TAM PROVISION an action to recover a penalty brought on by an informer in a situation in which one portion of recovery goes to the informer and the other portion to the state or government
MANUEL REVIEW AND FLAG all claims even those that are typicaly wiuld be processed automatically will be flaged if a practice or provider is found guilty of fraud.
LINE ITEM represent one line of the claim
COMPLAINCE PROGRAM a process of meeting regualtions, recommedations and expectations of federal and state agenies that pays for healtth service.
HEALTH INSURANCE PORTABLY AND ACCOUNTABLE ACT a set of standards that are required the the confidentiality of patients records and the processing of health care claims.
EXPLANATION OF BENEFITS a document detailing services billed and descibing payment determinatons.
FISCAL INTEREDIARY an oganization that processes claims for care recived
CLEAN CLAIM a claim submitted on time w/ all the nessary info so that it can be processed and paid promptly
Created by: markitaboyles