Key Terms
Fraud
Let the master answer
Respondeat Superior
COBRA stands for
Consolidated Omnibus Reconciliation Act
DEERS
Defense Enrollment Eligibility Reporting system
Per Member Per Month
Capitation
Actions inconsistent with sound medical, business and fiscal practices
Linking diagnosis codes with correct procedure codes
Medical Necessity
EDI
Electronic Data Interchange
CMS
Centers for Medicare and Medicaid Services
Policyholder
Subscriber/one who holds the policy
Health care service determined by the state that a medical professional can perform based on their education and training
Scope of Practice
Statute of Limitations
ADA
Americans with Disability Act
CHAMPUS
CoPayment
fixed amount due at the time of service
A court order that requires a witness to appear at a particular time and place
subpoena
Prior-approval
Preauthorization
DRG
Diagnosis Related Group
DME
Durable Medical Equipment
Co-Insurance
Percentage due after services are rendered
Provided from the Payer usually accompanied with payment
Remittance advice
Liability Insurance that covers physicians and other health care professionals for liability claims
Medical Mal-Practice
CHAMPVA
Civilian Health and Medical Program of Veterans Affairs
CPT
Current Procedural Terminology
Continuity of Care
Continuous care without a lapse