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24 Cards in this Set
- Front
- Back
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Adjustment |
Any change made to patients account. |
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Allowed charges |
Maximum amount an insurance payer considers the reasonable charge for medical services |
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Excluded services |
Services that are not covered by insurance policy |
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Eob |
Print out of info regarding a visit that shows what services are covered and what was paid by the insurance company |
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Manual review |
Process of removing a claim from the automated system to be looked over by a claims examiner |
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Medicare conversion factor (MCF) |
Value that converts the total relative value into a payment amount for reimbursement to the provider |
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Medicare fee schedule |
List of maximum amount medicare will pay for a procedure or service |
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Out-of-pocket expense |
Any medical service that is not paid by insurance company |
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Reason code |
Numeric or alphabetic code that is assigned when an adjustment has been made to a claim |
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Relative value unit |
Formula used by medicare to measure the value of cost for reimbursement to the provider it's based on the time spent and skill require to preform procedure. |
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Resourced-based fees |
Charge determination for service provided based off of 3 factors. |
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RBRVS |
Payment schedule system for the resources used during a procedure of service |
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Turn around time |
Time it takes an insurance carrier to process a claim after receiving it |
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Usual customary and resonable |
Determination of fees based on the consideration of what the provider charges the range of fees for other providers in the same specialty |
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Write offs |
Negative adjustments to a patient's account the difference between billed amount and allowed amount |
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Step 1 to determine MFS |
1.determine cpt code |
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Step 2 |
Determine the relative value unit |
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Step 3 |
Determine geographic practice cost idex |
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Step 4 |
Multiple each RVU by the gpci |
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Step 5 |
Add the three adjusted totals |
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Step 6 |
Times the sum by the conversion factor |
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1st factor in resourced based fees |
How difficult it was |
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2nd factor |
Staff involved |
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3rd step |
Risk involved for patient and provider |
