week 1 terms
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| ABN | advance beneficiary notice
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| MMA | medicare prescription improvement & modernization act
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| CMS | centers for medicare and medicaid services
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| SOF | signature on file
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| SSI | social security income
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| HCFA | health care financing administration
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| CMS-1500 | centers for medicare and medicaid services health insurance claim form
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| RBRVS | resource based relative value scale
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| RVU | relative value unit
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| RA | remittance advice
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| MG | medigap
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| ERA | electronic remittance advice
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| PDP | private prescription drug plan
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| EOB | explaniation of benefits
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| CCI | correct coding initiative
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| ESRD | end stage renal disease
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| LCD | local coverage decisions
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| advanced beneficiary notice | an agreement given to the patient to read and sign before rendering a service that maybe denied or paid
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| assignment | an agreement signed by the patient that assigns the right to recieve 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 procedure codes for professional medical services rendered to patients
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| crossover claim | a calim automatically sent electronically to the secondary payer when a person has both primary and secondary insurances
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| hospice | a public agency or private organization primarily engaged in providing pain relief symptom management or terminally ill and their families
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| respite care | short term inpatient stay for a terminally ill patient to give temporary relief
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| medical necessity | the performance of services and procedures that is consistant with the diagnosis
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| medicare part a | hospital coverage no charge
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| medicare part b | outpatient coverage
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| medi-medi | individual who recieves medicaid and medicare simutaneously
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| remittance advice | document detailing services billed and describing payment determination issued to providers
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| medicare secondary payer | primary insurance plan of medicare beneficiary that must pay for any medicare or services first before medicare is sent a claim
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| whistleblowers | suspected or defrauding the federal government
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| established patient | individual who has recieved professional care within the past 3 years from the physician or another physician in the same group practice
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| 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
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| review of systems | inventory of systems related to the chief complaint
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| 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
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| initial visit | first visit during an episode of care
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| subsequent visit | visits after the initial or first visit of an episode of care
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| medicare | a federal health insurance program for people over 65 or certain disabled/blind people or renal disease regardless of income
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