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Healthcare Abbreviations 1

100

• This term describes a system of classifying inpatient stays for payment. The CMS uses these to derive standard reimbursement rates for medical procedures and to pay hospitals for Medicare recipients. Some states use these for all payors and some private health plans use these for contracting

What is DRG (Diagnosis Related Group)

200

• The term used for the federal taxpayer number that identifies the provider/physician/practice/supplier to whom payment is made for service

What is Tax-ID

300

The term used to describe decisions made by Medicare Administrative Contractor whether to cover a particular item or service in their jurisdiction is known as

What is LCD

400

• The term used to describe when the insurance company changes the code(s) used and reduces the corresponding charges of a claim when there is no documentation to support the level of service submitted by the payor is known as:

What is downcoding

500

• In insurance billing, this term refers to the process of translating the services rendered to a patient into a standard set of medical codes. These codes make it easy for insurance companies to process claims. This term is known as:
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What is coding

Healthcare Abbreviations 2

100

This term is used as justification of medical services as reasonable, necessary, or appropriate

 What is medical necessity

200

The term used to describe a reference to the difference between what a provider charges and what an insurance plan allows. This amount is typically removed by the provider without the patient being responsible to pay is known as

What is allowable amount

300

• The term used for the system that is part of the FISS in which a user can perform functions such as: Enter, correct, adjust or cancel Medicare Part A billing transactions. This is also used to inquire about the status of claim:

What is DDE

400

• What is the term for the amount (typically a percentage) a patient is obligated to pay for covered medical services after they’ve satisfied any copay payment or deductible required by their health insurance plan

What is coinsurance

500

• What is correct term for the code that indicates the reasons that the payor made the adjustment or denial. If the payor does not report this term on the electronic remittance advice, this indicates that no adjustment was made:

What is CARC (claim adjustment reason code)

Healthcare Abbreviations 3

100

• The term used for a facility or program that provides care for people who are terminally ill. This is covered under Medicare Part A:

What is hospice

200

• The term used to describe submission of several CPT treatment codes when only one code is necessary

What is unbundling

300

The term used to describe the insurance where the provider is paid for each service or procedure provided. Typically allows the patient to choose physician and facility:

What is Fee for Service

400

• The cumulative amount that a patient must pay (usually annually) before benefits will be paid by the insurance company is known as:

What is deductible

500

• Emergency room visits, lab rest or radiology test not provided during an in-patient stay, surgery performed in one day or 23/24 hour observation in a hospital/facility (billed on UB-04 as an outpatient claim). This term is know as which of the following:
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what is bedded outpatient

Healthcare Abbreviations 4

100

• The term used to describe the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service

What is MUE (medically unlikely edits)

200

• The process done by a claim editing system/clearinghouse to check bills for errors before sending the payment to the insurance carrier for processing is known as:

What is scrubbing

300

• This term is used to describe conditions for which the insurance company will not pay i.e. cosmetic procedures:

 What is exclusions

400

• An agreement between health insurers to prevent double payment for the patient’s care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility is known as:

What is COB (coordination of benefits)

500

• The extended coverage after loss of employment insurance. A health insurance plan that offers eligible employees and their dependents extended health insurance coverage for the plan they’re on, in the event that hey lose their job or their hours are reduced is known as what?

What is COBRA

Healthcare Abbreviations 5

100

• The term that promotes national correct coding methodologies and reduces improper coding leading to inappropriate payments in Medicare and Medicaid

What is NCCI (National Correct Coding Imitative)

200

• The term used to describe a two-character code that is added to a procedure code to demonstrate an important variation that does not, by itself, change the definition of the procedure:

What is modifier

300

• The term used to describe the set of fixed dollar amount a patient is required to pay each time a particular medical service is used:

What is copay

400

• The practice of a provider billing for all charges not paid by the insurance plan, even if those charges are above the plan’s usual, customary and reasonable (UCR) charges or are considered medically necessary. This practice is illegal in several US states is know as what?

What is balance billing

500

• What is the healthcare term that is defined as: A rule, provisioned by CMS, that states that any outpatient diagnostic or other medical services performed within a specified number of hours before being admitted to a hospital must be combined and billed together and not separately is known as what?

What is 72 Hour Rule