Emr Chapter 7

Front 1

abuse

Back 1

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.

Front 2

coding variance

Back 2

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.

Front 3

CPT-4 (Current Procedural Terminology, fourth edition)

Back 3

a comprehensive set of medical codes and corresponding labels that describes procedures, treatments, and services for the purpose of determining reimbursement rates.

Front 4

electronic data interchange (EDI)

Back 4

an information exchange technology that facilitates the rapid accurate transfer of encrypted data in a standardized, mutually agreed-upon format

Front 5

encounter form

Back 5

a form generated to reflect the services and changes for a patient visit, it includes patient information, account balance, and follow-up instructions.

Front 6

fraud

Back 6

presenting (or causing to be presented) claims for serivices that an individual or entity knows or should know to be false.

Front 7

guarantor

Back 7

the person who bears ultimate financial responsibility for a patient's account.

Front 8

HIPAA 5010

Back 8

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.

Front 9

ICD-CM 10

Back 9

International Classification of Diseases , Tenth Edition, with Clinical Modification. a coding system used to describe inpatient and outpatient diagnoses.

Front 10

medical coding

Back 10

the process of assigning standard numeric or alphanumberic codes to diagnoses, procedures, and treatments for research, disease tracking, and reimbursement purpsoses.

Front 11

medical identity theft

Back 11

the unauthorized use of someone else's personal information to obtain medical services or submit fraudulent medical insurance claims for reimbursement.

Front 12

pay for performance (P4P)

Back 12

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.