-
pre-determined 12 month period for financial purposes
Fiscal year
-
pt with more than 1 insurance; nothing to do with birthday rule
Coordination of Benefits
-
Usual Customary and Reasonable
UCR
-
OV
Office Visit - CPT Book
-
CPT
Current Produral Terminology
-
ICD
International Classification of Diseases
-
HCPCS
Healthcare Common Procedure Coding System
-
PPO
Preferred Provider Organization; network together to offer discounts
-
PCP
Primary Care Physician
-
HMO
Health Maintenance Organization; usually require pre-authorization
-
CMS
Centers for Medicare and Medicaid Services
-
CMS-1500
health insurance form
-
CHAMPVA
insurance for spouses and unmarried dependents of a veteran who is diabled or died or a service related injury
-
Tricare
insurance for dependents of active duty and retired military personnel and dependents of those who died in active duty
-
EOB
Explanation of benefits
-
Co-insurance
the percentage paid by the company or the insured
-
Co-payment
small payment required when seen by the provider
-
Statute of limitations
defines the period in which legal action can take place
-
Elective Procedures
procedures that are not medically necessary
-
Primary insurance
the policy with the earliest effective date
-
Pre-certification
determines whether a service or procedure is covered and if the insurance plan approves it as medically necessary
-
Unbundling
refers to separating the components of a procedure to increase reimbursement; fraudulent
-
Assignment of benefits
instruction to the insurance company about whom and where to make payment
-
Major medical
insurance designed to offset medical expenses of a catastrophic degree high deductible.
-
Does medicare have a deductible
yes
-
How much does medicare generally pay
80% of UCR after deductible
-
7 sections of the CPT
Anesthesia, surgery, pathology/lab, evaluation and management, radiology, medicine
-
2 major sections of ICD
Diagnostic and procedure
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Superbill
identifies the procedures performed, diagnoses, charges, and when to return.
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