Term
|
Definition
| Standard claim form used when a provider qualifies for a waiver fro electronic claims submission; also used for billing some Medicaid state agencies. |
|
|
Term
|
Definition
| Medicare regulation requiring that certain outpatient services within 72 hours of an inpatient admission must be included in the patient's inpatient claim and reimbursed under a DRG. |
|
|
Term
|
Definition
| HIPAA standard transaction used by hospitals to submit claims electronically. |
|
|
Term
|
Definition
| HIPAA standard transaction that replaces the 1500 and is required of almost all physicians. |
|
|
Term
ABN
Advance Beneficiary Notice of Noncoverage |
|
Definition
| A document given to the patient that states that the provider believes that Medicare will not or probably will not cover the specified item. |
|
|
Term
|
Definition
| Incidents or practices that, although not usually considered fraudulent, are inconsistent with acepted sound medical, business or fiscal practices, directly or indirectly resulting in unnecessary costs or improper reimbursement for services that fail to meet professionally recognized standards of care or that are medicall unnecessary. |
|
|
Term
|
Definition
| A method of accountig in which income is recognized at the time it is earned, even if not yet collected, and expenses are booked as they are incurred, even if not yet paid. |
|
|
Term
ADA
Americans with Disabilities Act |
|
Definition
| A law passed in 1990 that requires employers to make reasonable adjustments to the work site to accommodate a disabled employee's ability to perform the job and requires bulildings to be accessible to those with disabilities. |
|
|
Term
|
Definition
| The total number of patient days in a given time period divided by the number of days in that period. |
|
|
Term
ALJ
Administrative law Judge |
|
Definition
| One of the five levels of Medicare appeals. |
|
|
Term
ALOS
Average Legnth of Stay |
|
Definition
| the total number of patient days divided by the number of discharges |
|
|
Term
AMA
American Medical Association |
|
Definition
| The group that owns the copyright for, and anually maintains CPT codes. |
|
|
Term
ANSI
American National Standards Institute |
|
Definition
| The group that established standards for electronic data interchange within healthcare. |
|
|
Term
APC
Ambulatory Payment Classification |
|
Definition
| A system that places outpatient services into groups based on similar procedures and resource use. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Procedures to protect assets from theft. |
|
|
Term
|
Definition
| Those things a business owns that have a value. |
|
|
Term
|
Definition
| An aggreement that Medicare payments will be sent to the office rather than the patient; the physician acccepts what Medicare allows as payment in full. |
|
|
Term
|
Definition
| A type of review in which RAC identifies a potential issue and uses its database to find improper payments; the provides is then given notification of denied claims. |
|
|
Term
|
Definition
| A deduction from revenue when an account is determined to be uncollectible. |
|
|
Term
|
Definition
| A financial satement that is a snapshot in time of the business. |
|
|
Term
CAH
Critical Access Hospital |
|
Definition
| A small hospital that serves a rural community |
|
|
Term
|
Definition
| The kind of asset that cannot be easily turned into cash, such as land, buildings, and large equiptment. |
|
|
Term
|
Definition
| A payment method in which a physician contracts to deliver services to a set population base; the physician is paid on a per-person basis. |
|
|
Term
|
Definition
| A method of accounting in which income is recognized when it is collected and expenses are booked when they are paid. |
|
|
Term
|
Definition
|
|
Term
CCI
Correct Coding Initiative |
|
Definition
| A system of edits that apply to physician services to identify pairs of codes that cannot be billed together, pairs that can be billed only with modifiers, and things that dont make sense. |
|
|
Term
CCP
Coordination Care Plans |
|
Definition
| Include health maintenance organizations, provider-sponsored organizations, and preferred provider organizations. |
|
|
Term
CDC
Centers for Disease Control and Prevention |
|
Definition
| A federal agency with functions that include monitoring health, detecting and investigating health problems; and preparing for new health threats. |
|
|
Term
|
Definition
| A type of personal bankruptcy in which the debtor does not have any means to repay the debts; the assets, if any are divvided among the creditors according to precedence. |
|
|
Term
|
Definition
| A type of personal bankruptcy in which the debtor has a regular income high enough to support a repayment plan over time. |
|
|
Term
|
Definition
| A computer listing of all charges that might be posted to a patient account; also called the fee schedule, item master, and other similar names. |
|
|
Term
|
Definition
| A deduction from revenue for care provided under preset financial guidelines. |
|
|
Term
CHIP
Children's Health Insurance Program |
|
Definition
| A state and federal partnership created in 1997 that targets uninsured childreb abd pregnant women in families with incomes too high to qualify for most state Medicaid programs, but often too low to afford private coverage. |
|
|
Term
CLIA
Clinical Laboratory Improvement Act |
|
Definition
| A regulation that provides for the registration, certification, and inspection of all laboratory sites. |
|
|
Term
|
Definition
| Community Mental Health Center |
|
|
Term
CMS
Ceters for Medicare and Medicaid Services |
|
Definition
| A federal agency responsible for developing rules and regulations that govern Medicare and Medicaid; it also contracts with entities who administer Medicare benefits in various regions of the country. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| The percentage of allowable charges which the patient must pay after paying his or her deductible. |
|
|
Term
|
Definition
| Health insurance that covers individuals; most often can be obtained as a benefit of employment, individual policies can be purchased by people who do not get insured through an employer. |
|
|
Term
|
Definition
| A type of review in which RAC requests medical records and makes its determination from them. |
|
|
Term
|
Definition
| A two-digit UB code that clarifies an event or condition related to the bill that may affect payer processing. |
|
|
Term
|
Definition
| A situation where one or more parties to an arrangement have an opportunity to exploit their position for personal or business advantage. |
|
|
Term
|
Definition
| The percentage at which a payer will reimburse the provider; also called the reimbursement rate. |
|
|
Term
CPT
Current Procedural Terminology |
|
Definition
| A system of terms and five-digit alpha-numeric codes that are used primarily to identify medical services and procedures furnished by phisicians and other healthcare professionals. |
|
|
Term
|
Definition
| An asset that is cash, or can quickly be tunred into cash, such as AR, checking account balances, and inventory. |
|
|
Term
|
Definition
| Those things that a business owes and are expected to be settled in cash within one year, sich as wages, taxes and accounts payable. |
|
|
Term
|
Definition
| An amount that a patient must pay for healthcare before the payer begins to pay. |
|
|
Term
DEERS
Defense Enrollment Eligibility Reporting System |
|
Definition
| The system in which military dependents must be enrolled to receieve benefits under TRICARE |
|
|
Term
|
Definition
| Designated Health Service |
|
|
Term
DME
Durable medical Equiptment |
|
Definition
| Any equiptment that can withstand repeated use, is used for a medical purpose, is of generally no use in the absence of illness, and is intended for use in the home. |
|
|
Term
|
Definition
| Durable Medical Equiptment, Prosthetics, Orthotics, and Supplies |
|
|
Term
DMERC
Durable Medical Equiptment Regional Carrier |
|
Definition
| A MAC to which DME is billed. |
|
|
Term
DNFB
Discharged, Not Final Billed |
|
Definition
| An account for a patient who has completeed treatment but has not had a claim produced. |
|
|
Term
|
Definition
| A doccument that states that the patient does not wish to have CPR or similar interventions performed in the event of a medical emergency. |
|
|
Term
|
Definition
|
|
Term
DRG
Diagnosis-Related Group |
|
Definition
| A group of services that has a payment weight assignned to it, based on the average resources used to treat Medicare patients in that DRG. |
|
|
Term
|
Definition
| An individual who is entitled to Medicare Part A and/or Part B, and is also eligible for some form of Medicaid benefit. |
|
|
Term
| Durable Power of Attorney for Healthcare |
|
Definition
| A doccument that designates someone else (known as a surrogate, agent, or healthcary proxy) to make decisions on the patient's behalf if he or she is unable to do so; also called a Healthcare Power of Attorney. |
|
|
Term
|
Definition
| Supplementary ICD codes that capture the external cause of injury or poisoning, the intent, and the place where the event occured. |
|
|
Term
E & M
Evaluation and Management |
|
Definition
| One range of CPT codes that apply to both the process of and the charge for examining a patient and formulating a treatment plan. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Electronic Data Interchange |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Electronic Medical Record |
|
|
Term
EMTALA
Emergency Medical Treatment and Labor Act |
|
Definition
| A law passed in 1986 in response to concerns that hospital were refusing to treat patients without insurance, and even transferring them to other facilities and leaving them there, sometimes without notifyinfg the receiving facility; also known as the Federal Anti-Dumping Statute. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| What a business is worth, as determined by the difference between assets and liabilities. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Electronic Remittance Advice |
|
|
Term
ERISA
Employee Retirement Income Security Act |
|
Definition
| A federal law passed in 1974 that governs self-insured plans. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Obligations that arise when a business has to pay for things. |
|
|
Term
FDA
Food and Drug Administration |
|
Definition
| A federal Agency responsible for approving or not, new drugs and meical devices, as well as safety in the medical and food industries. |
|
|
Term
FDCPA
Fair Debt and Collection Practices Act |
|
Definition
| A law that went into effect in 1996 to amend the Consumer Credit Protection Act. |
|
|
Term
|
Definition
| A payment method in which services are paid for on a fee schedule basis. |
|
|
Term
|
Definition
| The oldest method of payment; charges are considered in full without application of any discount. |
|
|
Term
FMLA
Family Medical Leave Act |
|
Definition
| A law established in 1993 allowing certain employees to take unpaid leave because of their own "serious health condition" or that of a family member, or the birth or adoption of a child. |
|
|
Term
|
Definition
| An internal deception or misrepresentation that an individual knows to be false or does not believe to be true, and knows that the deception could result in some unauthorized benefit to himself/herself or some other person. |
|
|
Term
FTC
Federal Trade Comission |
|
Definition
| A federal agency responsible for consumer protection. |
|
|
Term
GAAP
Generally Accepted Accounting Principles |
|
Definition
| "Rules" used to standardize accounting practices so that interested parties can interpret the true picture of a financial report. |
|
|
Term
GDRO
Gross Days Receivable Outstanding
|
|
Definition
| The average time it takes for AR to turn over completely. |
|
|
Term
|
Definition
|
|
Term
GPCI
Geographic Practice Cost Index |
|
Definition
| An adjustment to account for differences in wages and other costs among different geographic areas of the country. |
|
|
Term
|
Definition
| Hospital Acquired Condition |
|
|
Term
HCFA
Health Care Finance Administration |
|
Definition
| The original name for CMS |
|
|
Term
HCPCS
Healthcare Common Procedure Coding System |
|
Definition
| A milti-level coding system to relay information in healthcare transactions. |
|
|
Term
| Healthcare Power of Attorney |
|
Definition
| A doccument that designates someone else (known as a surrogate, agent or healthcare proxy) to make decisions on the patient's behalf if he or she is unable to do so; also called a Durable Power of Attorney for Healthcare. |
|
|
Term
|
Definition
|
|
Term
HHS
U.S. Department of Health and Human Services |
|
Definition
| The principal agency for protecting the health of all Americans. |
|
|
Term
HINN
Hospital-Issued Notice of Noncoverage
|
|
Definition
| A liability notice similar to an ABN hat affects providers submitting claims to fiscal intermediaries for hospital inpatient services. |
|
|
Term
HIPAA
Health Insurance Portability and Accountability Act |
|
Definition
| A law enacted in 1996 with the primary objective of protecting insurance subscribers from loss of coverage due to job changes, but with other, far-reaching consequences for healthcare. |
|
|
Term
HMO
Health Maintenance Organization |
|
Definition
| A plan that provides or arranges for comprehensive healthcare services in exchange for a fixed premium. |
|
|
Term
|
Definition
| Services available to Medicare beneficiaries who cannot leave their residence except in very limited circumstances. |
|
|
Term
|
Definition
| History of Present Illness |
|
|
Term
|
Definition
| Health Practitioner Shortage Area |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
ICD
International Classification of Diseases |
|
Definition
| A code set to relay information in healthcare transactions. |
|
|
Term
|
Definition
| The result of subtracting expenses from revenue. |
|
|
Term
|
Definition
| A financial statement that is a record over a set period of time and used to evaluate an organization's ability to pay present and future debts, and to earn revenue that exceeds expenses; also called Profit and Loss Statement. |
|
|
Term
IRF
Inpatient Rehabilitation Facility |
|
Definition
| A type of facility that provides services to patients that need rehabilitation services to improve the individual's overall physical condition. |
|
|
Term
|
Definition
| A legally verified claim against a debtor validated by the court; a legal right to collect a debt that can be used to obtain a lien. |
|
|
Term
LCD
Local Coverage Determination |
|
Definition
| A decision by a fiscal intermediary or carrier whether to cover a particular service on an intermediary-wide or carrier-wide basis. |
|
|
Term
|
Definition
| Those things that a business owes; debts. |
|
|
Term
|
Definition
| Coverage for non-work-related accident through property and casualty or auto insurance. |
|
|
Term
|
Definition
| A recorded claim against real or personal property, generally arising out of a debt; if the property is sold by the debtor, the creditor must be paid out of the procedes of that sale. |
|
|
Term
|
Definition
| A document that specifies what treatments a patient does and does not wish to receieve. |
|
|
Term
|
Definition
| A bank service in which payments are routed from a post office box directly to the bank, which opens the mail and deposits the monies. |
|
|
Term
|
Definition
| A temporary substitute, especially for a doctor or member of the clergy. |
|
|
Term
|
Definition
| A temporary substitute, especially for a doctor or member of the clergy. |
|
|
Term
|
Definition
| A form of acute care for patients who are expected to stay more than 25 days; also sometimes refers to custodial care that is offered in nursing homes. |
|
|
Term
MAC
Medicare Administrative Contractor |
|
Definition
| A private firm that processes Medicare claims; formerly known as fiscal intermediary or carrier. |
|
|
Term
MDC
Major Diagnostic Category |
|
Definition
|
|
Term
|
Definition
| Part of the federally required process for clinical assessment of all residents in Medicare-or Medicaid-certified nursing homes; the MDS then determines the RUG and hence the payment. |
|
|
Term
|
Definition
| Providers are using certified EHR technology to achieve health and efficiency goals including reducing errors; making records data available; generating reminders and alerts; supporting clinical decisions; and automating e-prescribing/refills. |
|
|
Term
|
Definition
| A program signed into effect in 1965 to assure that the vulnerable have access to medical care; funding is shared by federal and state governments; also known as Title XIX. |
|
|
Term
MIC
Medicaid Integrity Contractor |
|
Definition
| A third-party firm contracted to find Medicaid overpayments. |
|
|
Term
|
Definition
| A program signed into effect in 1966 to assure that the elderly could get medical care; later expanded to cover those under 65 with disabilities or ESRD; also known as Title XVIII. |
|
|
Term
|
Definition
| Supplementary coverage available only to persons enrolled in Medicare Part A and Part B. |
|
|
Term
MIC
Medicaid Integrity Contractor |
|
Definition
| A third-party firm contracted to find Medicaid overpayments. |
|
|
Term
MMA
Medicare Prescription Drug, Improvement, Modernization Act of 2003 |
|
Definition
| A law creating an exception to the physician self-referral prohibition for non- monetary remuneration used soley to receive and transmit electronic prescription information; commonly called Stark I, Stark II, and Stark III. |
|
|
Term
|
Definition
|
|
Term
MSN
Medicare Summary Notice |
|
Definition
| A statement reflecting services received, charges submitted, charges allowed, amount for which the beneficiary is responsible, and the amount that was paid to the provider or beneficiary; may also specify deductible and coinsurance amounts; also known as remittance advice and formerly known as the Medicare Explanation of Benefits. |
|
|
Term
MSP
Medicare Secondary Payer |
|
Definition
| Laws that shifted costs from the Medicare program to other sources of payment. |
|
|
Term
MUE
Medically Unlikely Edit |
|
Definition
| A program to reduce the error rate for Medicare claims; for example, this program would detect a claim for a person having "ten legs amputated." |
|
|
Term
NCD
National Coverage Determination |
|
Definition
| A determination of the extent to which Medicare will cover specific services, procedures, or technilogies on a national basis. |
|
|
Term
NIH
National Institue of Health |
|
Definition
| The primary federal agency for conducting and supporting medical research. |
|
|
Term
NLRB
National Labor Relations Board
|
|
Definition
| A government agency that looks into unfair labor practices, including union organization issues and collective bargaining; it governs breaks, overtime, and similar issues. |
|
|
Term
| Noncovered Service or Charge |
|
Definition
| A service or charge for which there is no coverage and, therefore, no payment by the insurance payer. |
|
|
Term
NOP
Notice if Privacy Practices |
|
Definition
| A notice that explains how the provider will maintain the patient's privacy and how patient information will be used by the facility; HIPAA requires providers to give all patients the NOP once in their lifetime and then again if the content of the NOP changes. |
|
|
Term
NPDB
National Practitioner Data Bank |
|
Definition
| An information clearinghouse to collect and release information regarding medical and malpractice payments and other adverse professional actions taken against physicians. |
|
|
Term
NPI
National Provider Identification |
|
Definition
| A coding system to identify providers, as dictated by CMS's Administrative Simplification Identifier Standards. |
|
|
Term
OASIS
Outcome and Assessment Information Set |
|
Definition
| An assessment made by a home health care provider, which determines a payment rate. |
|
|
Term
|
Definition
| A two-digit UB code and a date that together clarify a significant event or condition related to a claim. |
|
|
Term
|
Definition
| A two-digit code followed by two dates that identify a span of time relevant to claim processing. |
|
|
Term
OCE
Outpatient Code Editor |
|
Definition
| A system of edits that apply to hospital outpatient services under the hospital OPPS to identify pairs of codes that cannot be billed together, pairs that can be billed only with modifiers, and things that dont make sense. |
|
|
Term
OIG
Office of Inspector General |
|
Definition
| A federal agency with the mission to protect the integrity og HHS programs and the health and welfare of the beneficiaries of those programs; it has a major role in investigating fraud and abuse, and in issuing Advisory Opinions. |
|
|
Term
OPPS
Outpatient Prospective Payment System |
|
Definition
| Medicare's system that applies to most outpatient services, partial hospitalization services in CMHCs, and Part B-covered inpatient services if Part A coverage is exhausted. |
|
|
Term
|
Definition
| The maximum that a patient must pay on his or her own because the costs are not covered by any payer. |
|
|
Term
|
Definition
| The hospital insurance component of Medicare. |
|
|
Term
|
Definition
| The medical insurance component of Medicare. |
|
|
Term
|
Definition
| The Medicare Advantage component of Medicare; formerly known as Medicare+Choice. |
|
|
Term
|
Definition
| The prescription drug component of Medicare. |
|
|
Term
|
Definition
| Expectations that patients and their families can have about how they will be treated in healthcare situations. |
|
|
Term
PCP
Primary Care Physician |
|
Definition
| The family physician or "gatekeeper." |
|
|
Term
PDA
Pregnancy Discrimination Act |
|
Definition
| A law enacted in 1978 to prohibit discrimination against employees and applicants on the basis of pregnancy, childbirth, and related medical conditions. |
|
|
Term
|
Definition
| Latin for "for each day." |
|
|
Term
|
Definition
| A payment method in which the claim is paid at a predetermined percentage discount rate. |
|
|
Term
PFFS
Private Fee-For-Service |
|
Definition
| A type of Medicare Advantage plan. |
|
|
Term
|
Definition
| Personal Family Social History |
|
|
Term
PHI
Protected Health Information |
|
Definition
| Individually identifiable patient information protected under HIPAA. |
|
|
Term
|
Definition
| A physician referral of a Medicare patient for certain designated health services to an entity with which the physician or a member of the physician's immediate family has a financial relationship. |
|
|
Term
|
Definition
|
|
Term
POA Indicator
Present on Admission |
|
Definition
| A type of indicator paired with each diagnosis code in the medical record of an inpatient claim to help identify non-payable complications such as hospital-acquired infections, sponges left in patients, and so on. |
|
|
Term
|
Definition
| As related to financial policies, POS collections are the only cost-effective method of collecting small-dollar copayments. |
|
|
Term
PPO
Preferred Provider Organization |
|
Definition
| A fee-for-service arrangement or contract with a group of providers (the preferred providers) |
|
|
Term
PQRI
Physician Quality Reporting Initiative |
|
Definition
| A physician quality reporting system mandated by the 2006 Tax Relief and Health Care Act; it includes an incentive payment for eligible professionals who report data on quality measures for services furnished to Medicare beneficiaries. |
|
|
Term
|
Definition
| The process of gathering patient information and taking care of as many items as possible prior to the actual date of service. |
|
|
Term
|
Definition
| The process of obtaining advance insurance approval in order for payment to be secured later; also called preauthorization. |
|
|
Term
| Progressve Disciplinary Action |
|
Definition
| The process of documenting performance and behavior prior to, during, and after the entire disciplinary process; the documentation should reflect progression, sucess, or continued regression, and inability to perform satisfactorily. |
|
|
Term
PSO
Provider-Sponsored Organization |
|
Definition
| A type of Medicare Advantage plan |
|
|
Term
QMB
Qualified Medicare Beneficiary |
|
Definition
| An individual with financial resources and income at or below specified levels; these individuals do not have to pay their Medicare Part A/Part B premiums, deductibles, and coinsurance; their Medicaid program assumes these expenses. |
|
|
Term
RAC
Recovery Audit Contractor |
|
Definition
| A private firm charges with identifying under- and overpayments in Medicare and earning a contingency fee for denial of previously paid claims. |
|
|
Term
RAP
Request for Anticipated Payment |
|
Definition
| A request submitted by a home health care provider based on an Outcome and Assessment Information Set, which determines the payment rate; the provider receives half the payment up front and the remainder when the actual claim is submitted. |
|
|
Term
RBRVS
Resource-Based Relative Value Scale |
|
Definition
| A scale used by Medicare to determine the value of practitioner services. |
|
|
Term
|
Definition
| A regulation with the purpose to promote the informed use of consumer credit by requiring disclosures about its terms and cost; also called the Truth in Lending Act. |
|
|
Term
|
Definition
| The dollars generated when a business provides its services and generates a charge. |
|
|
Term
|
Definition
| A four-digit UB code that specifies an accoumodation or ancillary service category. |
|
|
Term
|
Definition
| Religious Fraternal Belief |
|
|
Term
|
Definition
| A document that defines a job to be done, asks for specific pricing, asks responders to explain what makes them the best choice, and asks for references. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| When an error on a claim does not pass Medicare's front-end edits, claims are returned to provider (RTP); the billing tema needs to review the claim, correct the information, and resend the UB. |
|
|
Term
RUG
Resource Utilization Group |
|
Definition
| The system used by Medicare to determine the payment rate for most skilled nursing care. |
|
|
Term
|
Definition
| The base value of a procedure in comparison to other procedures. |
|
|
Term
|
Definition
| A type of insurance in which a company does not purchase group insurance, but rather puts premium payments into a fund and pays a third party to administer benefits from the fund. |
|
|
Term
|
Definition
| The common term for patients who have no insurance. |
|
|
Term
|
Definition
| Efforts to locate correct information when an address or telephone number in an account turns out to be incorrect. |
|
|
Term
SNF
Skilled Nursing Facility |
|
Definition
| An institution or distinct part of an institution which provides skilled nursing care and services for residents who require medical or nursing care, or services for the rehabilitation of injured, disabled, or sick persons. |
|
|
Term
|
Definition
| Skilled Nursing Facility Prospective Payment System |
|
|
Term
SSA
Social Security Administration |
|
Definition
| A federal agency with the mission to protect the economic security of citizens; it is responsible for administering Medicare eligibiltiy. |
|
|
Term
| Stark I, Stark II, and StarkIII |
|
Definition
| The common name for Section 101 of the Medicare Prescription Drug, Imporvement, and Modernization Act of 2003 (MMA), so called because its chief sponsor was Congressman Pete Stark, and it was implemented in three phases. |
|
|
Term
|
Definition
| A sheet used to record data related to a patient encounter; it is preprinted with the most common E&M codes, procedures, diagnosis codes, common lab tests, etc.; also called the encounter form. |
|
|
Term
|
Definition
| A payment methodology in which small rural hospitals can choose to use beds for either acute or SNF care. |
|
|
Term
TCPA
Telephone Consumer Protection Act of 1991 |
|
Definition
| Legislation that restricts telephone solicitations and the use of automated telephone equiptment. |
|
|
Term
|
Definition
| A private agency that seeks to protect and improve the quality and safety of care; CMS allows TJC to accredit hospitals. |
|
|
Term
|
Definition
| A liability for an injury ot wrongdoing by one person to another resulting from a breach of legal duty; the entity held liable may look to its insurer to pay the claim; the creditor may file a lien against those insurance proceeds for payment when a settlement is made. |
|
|
Term
|
Definition
| Treatment, Payment, or Operations |
|
|
Term
|
Definition
| Coverage for active-duty service members, their spouses, and dependents, and retirees unless they are eligible for Medicare; formerly known as Champus. |
|
|
Term
|
Definition
| A regulation with the purpose to promote the informed use of consumer credit by requiring disclosures about its terms and costs; also called Regulation Z. |
|
|
Term
|
Definition
| The standard paper form used by many providers for billing insurance. |
|
|
Term
UCR
Usual Customary and Reasonable |
|
Definition
| A payment methodology that relied on physician-charge data accumulated over time to determine the value for services. |
|
|
Term
|
Definition
| A claim that cannot be processed due to incomplete or invalid information; when returned, it has not been denied and, as such, is not afforded appeal rights. |
|
|
Term
|
Definition
| Also called Case Management |
|
|
Term
|
Definition
| Supplemenary ICD codes used to describe encounters in circumstances other than disease or injury. |
|
|
Term
|
Definition
| U.S. Deparrtment of Veterans Affairs |
|
|
Term
|
Definition
| A two-digit UB code and its related amount or valur that together clarify an event or condition related to a claim. |
|
|
Term
|
Definition
| Coverage for a worker who is injured in the course of performing his or her job duties. |
|
|
