The flashcards below were created by user
ripken7
on FreezingBlue Flashcards.
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pre-determined 12 month period for financial purposes
Fiscal year
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pt with more than 1 insurance; nothing to do with birthday rule
Coordination of Benefits
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Usual Customary and Reasonable
UCR
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OV
Office Visit - CPT Book
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CPT
Current Produral Terminology
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ICD
International Classification of Diseases
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HCPCS
Healthcare Common Procedure Coding System
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PPO
Preferred Provider Organization; network together to offer discounts
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PCP
Primary Care Physician
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HMO
Health Maintenance Organization; usually require pre-authorization
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CMS
Centers for Medicare and Medicaid Services
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CMS-1500
health insurance form
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CHAMPVA
insurance for spouses and unmarried dependents of a veteran who is diabled or died or a service related injury
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Tricare
insurance for dependents of active duty and retired military personnel and dependents of those who died in active duty
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EOB
Explanation of benefits
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Co-insurance
the percentage paid by the company or the insured
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Co-payment
small payment required when seen by the provider
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Statute of limitations
defines the period in which legal action can take place
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Elective Procedures
procedures that are not medically necessary
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Primary insurance
the policy with the earliest effective date
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Pre-certification
determines whether a service or procedure is covered and if the insurance plan approves it as medically necessary
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Unbundling
refers to separating the components of a procedure to increase reimbursement; fraudulent
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Assignment of benefits
instruction to the insurance company about whom and where to make payment
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Major medical
insurance designed to offset medical expenses of a catastrophic degree high deductible.
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Does medicare have a deductible
yes
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How much does medicare generally pay
80% of UCR after deductible
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7 sections of the CPT
Anesthesia, surgery, pathology/lab, evaluation and management, radiology, medicine
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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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