Acronyms
CPB
What is Certified Professional Biller?
Law that created Medicare in 1965.
What is title XVIII of the Social Security Act?
An action that results in unnecessary costs to a federal healthcare program like Medicare and Medicaid
What is Abuse?
Standard format for conducting transactions electronically.
What is ASC X 12 Version 5010?
Act that laid the groundwork for a new CMS quality incentive payment program.
What is the Medicare Access and CHIP Reauthorization Act (MACRA)?
AMA
What is American Medical Association?
Federal law to make it easier for people to keep health insurance, to protect the confidentiality and security of health information and to reduce administrative costs.
What is the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?
Individually identifiable health information such as name, address, DOB, SSN, diagnoses, or payment information.
What is Protected Health Information (PHI)?
The Electronic Data Interchange (EDI) adopted under HIPAA contains how many standard transaction types?
What is 8?
Claims and encounter
Payment and remittance advice
Claims Status
Eligibility
Enrollment information
Referrals and authorizations
Coordination of benefits
Premium payments
Name of the new quality incentive payment program established by MACRA?
What is the Quality Payment Program (QPP)?
PHI
What is Protected Health Information?
Health Plans, clearinghouses, and healthcare providers who transmit health information as identified in the Privacy Rule.
What is a covered entity?
Managed care organization where patients do not need a primary care physician or referral for specialty care. Providers and facilities have agreed to reduced rates to provide care to the insurance clients.
What is a Preferred Provider Organization (PPO)?
Code set established by CMS for services not covered by CPT.
What is Healthcare Common Procedure Coding System (HCPCS)?
QPP Program that combines three older programs (PQRS, EHR Incentive/MU, and Value-based payment modifier (VM)).
What is the merit based incentive payment system (MIPS)?
HMO
What is Health Maintenance Organization?
Law to prevent someone from knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal health plan.
What is Anti-kickback?
An individual who is eligible for Medicare or Medicaid benefits.
What is a beneficiary?
Code set maintained by the American Medical Association (AMA) to describe procedures and services.
What is the Current Procedure Terminology (CPT)?
QPP program where a group of clinicians organize to deliver high quality care through coordinated efforts in exchange for higher risk and reward.
What i the Advanced Alternative Payment Model (APM)?
HITECH (Act)
What is the Health Information Technology for Economic and Clinical Health Act?
HPIAA rule that requires appropriate administrative, physical, and technical safeguards are in place to protect patient health information.
What is the security rule?
Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program.
What is Fraud?
Code set maintained by the National Center for Health Statistics, Centers for Disease Control. It was clinically modified for use in the U.S. Healthcare system.
International Classification of Diseases - 10th Revision - CM.
MIPS program that offers more meaningful groupings of quality measures and activities relevant to a specific specialty or medical condition.
What is the MIPS Value Pathways?