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37 Cards in this Set

  • Front
  • Back
physician's fee profile
compilation of each dr's charges & payments made to him oaver a given period of time for each specific service rendered to a pateint
primary diagnosis
initial identification of the condition or chief complaint for which the patient is treat for outpatient medical care
secondary diagnosis
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
syndrome
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
CC
patient's statement describing symptoms, problems, or conditions as the reason for seeking health care services from dr
CM
clinically modified
ICD-10-PCS
ICD-10- Procedure Coding System
LMRP
local medical review policy
NCHS
National Center for Health Statistics
SNOMED
Systemtatized Nomenclature of Human and Veterinary Medicine
ABCs
alternative billing codes
CF
conversion factor
DME
durable medical equipment
EMTALA
Emergency Medical Treatment and Active Labor Act
FTC
Federal Trade Commission
GAF
geographic adjustment factor
GPCIs
geographic practice cost indicies
NCCI edits
National Correct Coding Initiative edits
PC
professinal component
PPS
physician provider group
RVS
relative value studies
RVU
relative value unit
RBRBS
resource-based relative value scale
TC
technical component
UCR
usual, cusomary, resonable
comprehensive code
a single procedural code that describes 2 or more CPT codes bundled together
conversion factor
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
customary fee
the amount that a physician usually charges most of his or her patients
downcoding
this occurs when the coding system used by the physician office on a claim does nt match the coding system receiving the claim
fee schedule
a list of charges or established allowances for specific medical services and procedures
modifier
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
reasonable fee
a charge is deemed reasonable if it is deemed acceptable after peer review criteria.
relative vlue studies (RVS)
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
relative value unit (RVU)
a monetary value assigned to each service based on the amount of physician work, practice expenses, and professional liabiliby insurance
resource-based relative value scale (RBRVS)
a system that ranks physician services by units and proveds a formula to determine a Medicare fee schedule
upcoding
deliberate manipulation of CPT codes for increased payment
usual, customary, and reasonable (UCR)
a method used by insurance compaines to establish their fee schedules