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 |