FPP Facts
The full name of our new COO
Who is Vincent Orange Jr.
RCM
What is Revenue cycle Management
An explanatory phrase that has been assigned to describe a procedure, service or supply
What is a charge description
A four-digit numeric code required for billing on the UB-04 (institutional claim)
What is the Revenue Code
This occurs when a service is billed at a higher reimbursement level than the services that were actually provided, and includes an element of deception.
What is Fraud
The practice manager over the department of Medicine
Who is Natalie Robinson
CDM
What is Charge Description Master
Codes used by providers and facilities to identify or flag a service that has been modified in some way to provide more specific information about that procedure or service.
What is a modifier
The current code assigned by the AMA and CMS to be reported for individual services, procedures, and supplies rendered to the patient.
What is CPT/HCPCs code
One way this can occur is from overutilization of services, resulting in unnecessary healthcare costs.
What is waste
The person with the longest tenure within Suite 6101
Who is Sam Gaisie
EOB
Explanation of Benefits
Stores individual payer information so that data related to that payer doesn't have to be re-entered
What is a clearinghouse
A list of services and the associated amount that the insurance will pay for healthcare claims
What is a fee schedule
Provider practices that demonstrate a high rate of seeking reimbursement for services that are not deemed medically necessary can meet the criteria for this term.
What is abuse
The interim chair for the department of OGBYN
Who is Dr. Rochanda Mitchell
Continuous Positive Airway Pressure
The meaning for Neuro
What is nerve
The cost a policyholder must incur before the insurance plan assumes liability for the covered expense
This law prevents physician self-referral, or referring patients to a service in which the provider has a financial interest.
What is the Stark Law
The original name of the FPP
What is PPP (Physicians Practice Plan)
HIPAA
Health Insurance Portability and Accountability Act
The meaning of Patho
A pre-established percentage of eligible expenses after the deductible has been met
What is coinsurance
This law establishes criminal penalties for offering, providing, or receiving gifts or incentives for healthcare referrals.
What is the Antikickback Statute (AKS)