Acronyms
HIPAA
Health insurance portability and accountability act
This is when a provider accepts pre established payments for providing health care services to enrollees.
What is Capitation?
This coverage is attached to your health care plan to modify insurance contract.
What is a Rider?
Program that pays for Inpatient hospitalization, care in a skilled nursing facility, home health care, and hospice care
Medicare part A
A capitated provider prepays ancillary provider
Subcapitation
CHIP
What is children's health insurance program?
Automatically transmitted by primary payer to secondary payer.
What is crossover claim?
done to discover if a patient has an undiagnosed disease
What is screening service?
Remittance advice from Medicare sent to patients to explain how the claim was processed.
MSN
Which part of medicare covers roster billing?
Medicare part B
CCI
What is correct coding Intitative?
Payers issue when they approve services
What is Prior authorization number?
The computer to computer system of exchange data in a standardized format.
What is Transaction
Highest fee nonparticipating physicians may charge for a particular service.
Limiting charge
Employers' health plans structured to permit funding of premiums with pretax payroll deductions
Section 125 cafeteria plan
OSHA
What is Occupational Safety and Health Administration?
Editing software program used to check claims for error correction
What is claim scrubber?
low-risk laboratory tests done in doctor's office
what is Waived test?
Medicare plans other than the Original Medicare Plan, provided through private Insurance companies.
Medicare Advantage
Program focuses on incorrectly billed services
Medical review program
CLIA
What is clinical laboratory improvement amendments?
The process of encoding information in such a way that only the person or computer with a key can only decode it
What is encryption?
administrative code set used to report a physician's specialty
What is taxonomy codes?
Medicare beneficiary's identification number
Medicare health insurance claim number
Works for health plan and sets the discounts for out of network visits
Repricer