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4030 wk3
def bbv
| Question | Answer |
|---|---|
| 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
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