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25 Cards in this Set
- Front
- Back
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abuse
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acts committed that are not usually considered fraudulent that are inconsistent with accepted sound medical business or fiscal practices
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clearing house
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independant organization that receives claims from md offices that edits and processes the claims for insurance companies.
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compliance
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meeting state and federal regulations that pay for services and regulate the industry
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consent
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verbal or written agreement giving approval to some action, situation, or statement
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embezzlement
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wilful act of taking posession of employers money.
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fraud
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intentional misrepresentation of facts to decieve or mislead another.
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healthcare provider
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a provider of medical or health services and any other organizationor person who furnishes bills or is paid for healthcare in the normal course of business
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phantom billing
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billing for services not provided
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security rule
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under hipaa, rules/regulations regarding security of electronic health transactions and code sets
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standard
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a rule, condition, or requirement
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transaction
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transmission of information between 2 partiesto carry out financial or administrative activities related to healthcare.
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cci
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correct coding initiative
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clia
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clinical labratory improvement amendments.
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cms
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centers for medicare and medicaid services.
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cpt
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common procedural treminology
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edi
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electronic data interchange
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ein
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employer identification number
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hipaa
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health insurance portability and accountability act
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icd-9-cm
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international classificationof diseases, version 9,clinical modification
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ndc
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mational drug code
usually looks like xxxxx-xx-xxxx |
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npi
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national provider identification number
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ort
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operation restored trust
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snomed
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systemized nomenclature of human and veterinary medicine
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tpa
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third party administrator
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top
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treatment, payment, and healthcare operations
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