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12 Cards in this Set
- Front
- Back
abuse |
unintentional deception in which a provider inappropriately bills for services that are not medically necessary , do not meet current standards of care, or are not medically sound. |
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coding variance |
medical coding mistakes caused by computer error or by various kinds of human error, from simple carelessness to incorrect application of coding guidelines and procedures. |
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CPT-4 (Current Procedural Terminology, fourth edition) |
a comprehensive set of medical codes and corresponding labels that describes procedures, treatments, and services for the purpose of determining reimbursement rates. |
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electronic data interchange (EDI) |
an information exchange technology that facilitates the rapid accurate transfer of encrypted data in a standardized, mutually agreed-upon format |
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encounter form |
a form generated to reflect the services and changes for a patient visit, it includes patient information, account balance, and follow-up instructions. |
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fraud |
presenting (or causing to be presented) claims for serivices that an individual or entity knows or should know to be false. |
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guarantor |
the person who bears ultimate financial responsibility for a patient's account. |
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HIPAA 5010 |
the standard claim form used by a noninstitutional provided or supplier to submit a claim electronically to Medicare and most other insurance carriers for covered services. |
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ICD-CM 10 |
International Classification of Diseases , Tenth Edition, with Clinical Modification. a coding system used to describe inpatient and outpatient diagnoses. |
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medical coding |
the process of assigning standard numeric or alphanumberic codes to diagnoses, procedures, and treatments for research, disease tracking, and reimbursement purpsoses. |
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medical identity theft |
the unauthorized use of someone else's personal information to obtain medical services or submit fraudulent medical insurance claims for reimbursement. |
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pay for performance (P4P) |
an outcome-based payment model that offers providers financial incentives for meeting specific standards and electronically documenting compliance with them, punitive measures may be applied to providers who fail to comply. |