wk4 InsTerms/Acronym Word Scramble
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Term | Definition |
accept assignment | provider accepts as payment in full whatever is paid on the claim by the payer (except for any copayment and/ or coinsurance amounts.) |
allowed charges | the maximum amount the payer will reimburse for each procedure or service, according to the patient's policy. |
assignment of benefits | the provider receives reimbursement directly from the payer |
beneficiary | the person eligible to receive health care benefits |
birthday rule | determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan |
charge master | document that contains a computer generated list of procedures, services, and supplies with charges for each; charge master data are entered in the facility's patient accounting system, and charges are automatically posted to the patient's bill |
adjudication | judicial dispute resolution process in which an appeals board makes a final determination |
appeal | documented as a letter, signed by the provider, explaining why a claim should be reconsidered for payment |
clean claim | a correctly completed standardized claim (e.g., CMS-1500 claim). |
clearinghouse | performs centralized claims processing for providers and health plans |
downcoding | assigning lower-level codes than documented in the record |
guarantor | person responsible for paying health care fees |
litigation | legal action to recover a debt; usually a last resort for a medical practice |
MAC | Medicare administrative contractor |
Medi-Medi | Medicare/Medicaid crossover |
MPFS | Medicare Physician Fee Schedule |
MS-DRG | Medicare severity diagnosis-related group |
nonPAR | non participating provider |
NPI | National Provider Identifier |
OBRA | Omnibus Budget Reconciliation Act of 1981 |
OSHA | Occupational Safety and Health Administration |
OWCP | Office of Workers Compensation Program |
PAR | Participating Provider |
PCP | Primary Care Provider |
PHI | Protected Health Information |
PIN | Provider Identification Number |
POS | Place of Service |
PPO | Preferred provider organization |
RBRVS | resource based relative value system |
RVU | relative value unit |
SOAP | subjective, objective, assessment, plan |
Created by:
cheri le
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