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37 Cards in this Set
- Front
- Back
physician's fee profile
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compilation of each dr's charges & payments made to him oaver a given period of time for each specific service rendered to a pateint
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primary diagnosis
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initial identification of the condition or chief complaint for which the patient is treat for outpatient medical care
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secondary diagnosis
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reason subsequent to the primary diagnosis for an encounter that may contribute to the condition or define the need for a higher level of care but is not the underlying cause
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syndrome
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a set of complex signs, sypmtoms, or other manifestations resulting from a common cause or appearing in a combination presenting a distinct clincical picture of a disease or inhereited abnormality
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CC
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patient's statement describing symptoms, problems, or conditions as the reason for seeking health care services from dr
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CM
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clinically modified
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ICD-10-PCS
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ICD-10- Procedure Coding System
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LMRP
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local medical review policy
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NCHS
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National Center for Health Statistics
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SNOMED
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Systemtatized Nomenclature of Human and Veterinary Medicine
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ABCs
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alternative billing codes
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CF
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conversion factor
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DME
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durable medical equipment
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EMTALA
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Emergency Medical Treatment and Active Labor Act
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FTC
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Federal Trade Commission
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GAF
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geographic adjustment factor
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GPCIs
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geographic practice cost indicies
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NCCI edits
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National Correct Coding Initiative edits
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PC
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professinal component
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PPS
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physician provider group
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RVS
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relative value studies
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RVU
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relative value unit
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RBRBS
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resource-based relative value scale
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TC
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technical component
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UCR
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usual, cusomary, resonable
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comprehensive code
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a single procedural code that describes 2 or more CPT codes bundled together
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conversion factor
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the dollars and cents amount for one unit as applied to a procedure or service rendered, and then is used to convert procedures into fee-schedule payments
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customary fee
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the amount that a physician usually charges most of his or her patients
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downcoding
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this occurs when the coding system used by the physician office on a claim does nt match the coding system receiving the claim
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fee schedule
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a list of charges or established allowances for specific medical services and procedures
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modifier
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in CPT coding, a two-digit add-on number placed after the usuall procedure nuber to indicate that a px has been altered in a specific way
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reasonable fee
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a charge is deemed reasonable if it is deemed acceptable after peer review criteria.
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relative vlue studies (RVS)
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a list of procedure codes for professional services and procedures that are assigned unit values that indicate the relative value of one procedure over another
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relative value unit (RVU)
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a monetary value assigned to each service based on the amount of physician work, practice expenses, and professional liabiliby insurance
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resource-based relative value scale (RBRVS)
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a system that ranks physician services by units and proveds a formula to determine a Medicare fee schedule
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upcoding
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deliberate manipulation of CPT codes for increased payment
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usual, customary, and reasonable (UCR)
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a method used by insurance compaines to establish their fee schedules
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