terms and acronyms
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each of the black spaces below before clicking
on it to display the answer.
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| fraud | intentional deception or misrepresentation that could result in an unauthorized payment
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| abuse | actions inconsistent with accepted, sound medical, business, or fiscal practices
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| scope of practice | health care services, determined by the state, that an NP and PA can perform
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| respondent superior | Latin for "let the master answer"; legal doctrine holding that the employer is liable for he actions and omissions of employees performed and committed within the scope of their employment
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| Statute of limitations | a statute prescribing a period of limitations for bringing
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| subpoena | an order of the court that requires a witness to appear at a particular time and place to testify
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| stand-alone code | CPT code that includes a complete description of the procedure of service.
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| medical malpractice insurance | a type of liability insurance that covers physicians and other health care professionals for liability claims arising from patient treatment
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| medical necessity | involves linking every procedure or service code reported on an insurance claim to a condition code (e.g., disease, injury, sign, symptom, other reason from encounter) that justifies the need to perform that procedure or serve
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| preauthorization | prior approval
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| remittance advice(remit) | electronic or paper-based report of payment sent by the payer to the provider; includes patient name, patient health insurance claim (HIC) number, facility provider number/name, dates of service (from date/thru date), type of bill (TOB), charges
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| coinsurance | also called coinsurance payment; the percentage the patient pays for covered serves after the deductible has been met and the copayment has been paid
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| ABN | Advance Beneficiary Notice
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| ADA | Americans with Disabilities Act
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| CHAMPUS | Civilian Health and Medical Program of the Uniformed Services
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| CMS | Centers for Medicare and Medicaid Services
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| CMS 1500 | Insurance claim used by non-institutional and other selected providers and suppliers to bill payers
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| COBRA | Consolidated Omnibus Reconciliation Act
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| CPT | Current Procedural Terminology
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| DEERS | Defense Enrollment Eligibility Reporting System
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| DME | Durable Medical Equipment
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| DRG | Diagnosis Related Group
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| EDI | electronic data interchange
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