4020Terms and Abbreviations
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| Advanced Beneficiary Notice | an agreement given to the patient to read and sign before rendering a service that may be denied for payment.
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| Assignment | an agreement signed by the patient assigns the right to receive payment for the services from the insurance.
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| Correct Coding Initiative | Federal legislation that attempts to eliminate unbundling or other inappropriate reporting of procedural codes for professional medical services rendered to patients.
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| Crossover claim | The claim is automatically transferred sent electronically to the secondary payer when a person has both a primary and secondary insurance.
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| Hospice | A public agency or private organization primarily engaged in providing pain relief, symptom management, and support services to terminally ill patients and their families
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| Respite Care | is short term inpatient stay that may be necessary for terminally ill patients to give temporary relief to the person who regularly assists with home care.
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| Medical Necessity | Performance of service and procedures consistent with the diagnosis in accordance with standards of good medical practice performed at proper level and provided in the most appropriate setting.
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| Medicare Part A | Hospital benefits of a nationwide health insurance program for persons age 65 years of age and older and certain disabled individuals regardless of income, administered by CMS.
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| Medicare Part B | Outpatient coverage-- medical insurance of nationwide health insurance program for person 65 years of age and older and certain disabled individuals regardless of income, administered by CMS.
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| Medi-Medi | refers to an individual who has both Medicaid and Medicare benefits.
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| Remittance Advice | a document detailing services billed and describing payment determination issued to providers of the Medicare or Medicaid program; also known ins some programs as an explanation of benefits.
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| Medicare Secondary Payer (MSP) | Medicare is considered secondary, the primary insurance must be billed first and the Medicare second, with a copy of the EOB.
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| Whistleblowers | informants who report physicians suspected of defrauding the federal government.
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| Established Patient | an individual who has received professional services within the past 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
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| New Patient | an individual who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.
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| Review of Systems | an inventory of body systems obtained through a series of questions used to identify signs or symptoms that the patient might be experiencing or has experienced. Inventory of systems related to the chief complaint.
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| Key Elements | individualized steps in the identification of the correct E & M procedure codes for the services provided.
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| Initial Visit | the initial or first, visit during an episode of care.
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| Subsequent Visit | visits after the initial, or fist, visit during an episode of care.
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| Medicare | a federal nationwide health insurance program for persons age 65 years of age and older and certain disabled or blind persons regardless of income and those with ESRD.
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