Reimbursement Terminology Flashcards
Advance Beneficiary Notice
Notification in advance of services that Medicare probably will not pay for and the estimated cost to patient
Notification in advance of services that Medicare probably will not pay for and the estimated cost to patient
Advance Beneficiary Notice
ABN
Advance Beneficiary Notice
Ancillary Service
A service that is supportive of care of a patient, such as laboratory services
What is formerly WOL, Waiver of Liability?
Advance Beneficiary Notice
A service that is supportive of care of a patient, such as laboratory services
Ancillary Service
Assignment
A legal agreement that allows the provider to receive direct payment from a payer and the provider to accept payment as payment in full for covered services
A legal agreement that allows the provider to receive direct payment from a payer and the provider to accept payment as payment in full for covered services
Assignment
Attending Physician
The physician legally responsible for oversight of an inpatient’s care (in residency programs, the teaching physician that monitors the resident’s work)
The physician legally responsible for oversight of an inpatient’s care (in residency programs, the teaching physician that monitors the resident’s work)
Attending Physician
Beneficiary
The person who benefits from insurance coverage
The person who benefits from insurance coverage
Beneficiary
The Beneficiary is also know as:
(5)
Subscriber
Dependent
Enrollee
Member
Participant
Birthday Rule
When both parents have insurance coverage, the parent with the birthday earlier in the year carries the primary coverage for a dependent
When both parents have insurance coverage, the parent with the birthday earlier in the year carries the primary coverage for a dependent
Birthday Rule
Certified Registered Nurse Anesthetist
An individual with specialized training and certification in nursing and anesthesia administration
An individual with specialized training and certification in nursing and anesthesia administration
Certified Registered Nurse Anesthetist
CRNA
Certified Registered Nurse Anesthetist
“Clean Claim”
A properly completed claim submitted to a payer with all data fields containing current and accurate information and submitted within the timely filing period required by the insurer
A properly completed claim submitted to a payer with all data fields containing current and accurate information and submitted within the timely filing period required by the insurer
“Clean Claim”
Coinsurance
Cost-sharing of covered services
Cost-sharing of covered services
Coinsurance
Compliance Plan
Written strategy developed by medical facilities to ensure appropriate, consistent documentation within the medical record and ensure compliance with 3rd-party payer guidelines and the Office of the Inspector General (OIG) Workplan guidelines
Written strategy developed by medical facilities to ensure appropriate, consistent documentation within the medical record and ensure compliance with 3rd-party payer guidelines and the Office of the Inspector General (OIG) Workplan guidelines
Compliance Plan
Concurrent Care
More than 1 physician providing care to a patient at the same time
More than 1 physician providing care to a patient at the same time
Concurrent Care
Coordination of Benefits
Management of multiple 3rd-payments to ensure overpayment does not occur
Management of multiple 3rd-payments to ensure overpayment does not occur
Coordination of Benefits
COB
Coordination of Benefits
Co-Payment
Cost-sharing between beneficiary and payer
Cost-sharing between beneficiary and payer
Co-Payment
Deductible
That portion of covered services paid by the beneficiary before 3rd-party payment begins
That portion of covered services paid by the beneficiary before 3rd-party payment begins
Deductible
Denial
Statement from a payer that coverage is denied
Statement from a payer that coverage is denied
Denial
Documentation
Detailed chronology of facts and observations, procedures, services, and diagnoses relative to the patient’s health
Detailed chronology of facts and observations, procedures, services, and diagnoses relative to the patient’s health
Documentation
Durable Medical Equipment
Medically related equipment that is not disposable, such as wheelchairs, crutches, and vaporizers
Medically related equipment that is not disposable, such as wheelchairs, crutches, and vaporizers
Durable Medical Equipment
DME
Durable Medical Equipment
