Terms to Know
The Claim Game
Medicare/Medicaid
Toxicology
Billing
Revenue Cycle Acronyms
100
This organization creates and maintains the Current Procedural Test (CPT) codes.
What is the American Medical Association (AMA)?
100

A request for review of an insurance claim that has been underpaid or denied.

What is an appeal?
100
Parent drugs and metabolites are billed together as this.

What is drug class?


100
If you are not contracted with a HMO plan you are considered.
Out of network provider?
100
MSP
What is Medicare Secondary Payor
200
The only CPT code Molecular currently bills for toxicology screening.
What is 80307?
200
When a patient has multiple coverage, one payor being Medicaid. Medicaid is known as this.
What is the payor of last resort?
200
This type of toxicology screening is done in a provider's office usually to obtain a quick result.
What is a POC or POCT? Point of Care or Point of Care test?
200
The term used to describe the period of time a provider has to file a claim with a payor.
What is Timely Filing Deadline?
200
MCO

What is a Managed Care Organization?



300

A substance or chemical constituent that is undergoing analysis.

What is an analyte?
300
When filing a secondary claim, this is needed from the primary payor.

What is an EOB?

300
Definitive testing performed without a screen should only be done for this reason.
What is no screen available?
300
This code provides additional information on the EOB when the claim is denied.
What is a remark code, reason code or remit code?
300
LCD

What is Local coverage determination.


400
This type of toxicology testing will provide a quantitative result when possible and at a minimum a qualitative result.
What is Definitive or Confirmation testing?
400

This is often run or checked for patient health coverage. 

What is eligibility?
400


Medicare, most state Medicaid plans and the majority commercial plans bill with this codeset for toxicology.

What are G codes or HCPCS codes?


400
This amount listed on the Explanation of Benefits is the amount the provide should expect for payment, to include copays and or deductibles in addition to payor payment.
What is Allowed amount of allowable?
400
DOS
What is date of service?
500
These are often referred to as Level II Codes
What are HCPCS (Healthcare Common Procedure coding System) codes?
500
Radiology and laboratory providers are often times referred to as this in the insurance world.
What is an ancillary provider?
500
G code that is billed when 22 or more classes are definitively tested.
What is G0483?
500
When a payor takes the money to be refunded back electronically through a future payment.
What is a recoupment or take back?
500
CARC/RARC

What is remittance advice remark code and claim adjustment reason code?


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