Terminologies

ABN: (Advance Beneficiary Notice)

           An arrangement in which patient request their health benefit payment to be made directly to disignated physician or facility.

Medicare Limiting Charge:

           The medicare limiting charge is maximum fee for a procedure that can be charged by non-participating provider.

Incident- to- rules:

            Services supervised by physician but rendered by non-physician practitioner is billed under incident to rules.

Discounted fee for Service:

            The type of payment in which PPOs usually pays as per theirs contact tates to their providers is k own as Discounted fee for Service.

PECOS:

             Provider Enrollment, chain and ownership system. Enrolment with Medicare. Provider with PECOS certified, they authorize for DME prescribe.

Formulary:

             A list of prescruption drug costs which an i surance company will provide reimbursment for.

Fiscal Intermediary:

            A medicare representative who process medicare claims.

Healthcare Reform Act:

            It is also known ad Obama Healthcare Plan.

V codes and E codes:

              V codes used for diagnostic code, newborn status. Not for diseases, sick or injury. 1alpha, 1 numeric with one or two decimals.

            E codes used for external causes of injury.

MAC:

            Medicare Administrator Contractor. 3rd party vendor by Federal government.

Inclusive:

            The code which is used as supportive treatment with the main treatment usually says as inclusive with main code. Eg. Thermometer, Blood pressure check.

Global:

             Generally used for pregnancy or in case of surgery. The time period from pregnancy to post delivery period. Insurance will do one payment.

             

EOB: Explanation Of Benefit

COB: Co-ordination Of Benefit

POS: Place Of Service

ABN: Advance Beneficiary Notice

EOP: Explanation Of Payment

DOB: Date Of Birth

DOS: Date Of Service

NPI: National Provider Identifier

PTAN: Provider Transaction Account Number

IRS: Internal Revenue Services

HIPAA: Health Insurance Portability and Accountability Act

CHAMPVA: Civilian Health And Medical Program Of Veterans Affairs

CHAMPUS: Civilian Health And Medical Program Of Uniformed Services

CMS: Center for Medicare and Medicaid Services

PI: Payer Initiated Reduction

PR: Patient Responsibility

CPT: Current Procedural Terminology

HCPCS: Healthcare Common Procedure Coding System

CDT: Current Dental Terminology

ASA: American Society of Anesthesiologists

ERISA: Employee Retirement Income Security Act

COBRA: Consolidated Omnibus Budget Reconciliation Act

ICD-10 CM: International Classification of Diseases - 10th Revision Clinical Modification

DHHS: Department of Health and Human Services

AMA: American Medical Association

AMBA: American Medical Billing Association

UB 04: Uniform Billing 04 Claim form

CMS 1500: Center for Medicare and Medicaid Services 1500 Claim form

NUCC: National Uniform Claim Committee

AEVS: Automated Eligibility Verification System

AVRS: Automated Voice Response System

ALOS: Average Length of Stay

Auth: Authorization

BR: Breast

BC: Birth Control, Body Cell, Body Composition

BS: Blood Glucose, Bowel Sound

BC/BS: Blue Cross Blue Shield

CC: Chief Compliant

C/C: Credit Card

CAL-MAX: Calendar Max

CERT: Claims Eligibility Real Time System, Community Emergency Response Team

CSP: Community Support Program, Compulsive Skin Picking

CHIP: Child Health Insurance Program

CPC: Certified Professional Coder

Cont. Obj.: Contractual Obligation

DL: Driver License, Dose Level

DRG: Diagnosis Related Group (Patient with similar illness)

HCFA: Health Care financing Administration.

UCR: Usual Customary and Reasonable Charges.

HHC: Home Health Care.

Hospice: End stage disease/ severe case.

SNF: Skilled Nursing Facility.

DME: Durable Medical Equipment.

PHI: Protected Health Information.

ROI: Release of Information.

UR: Utilization Review.

UM: Utilization Management.