What is code that defines a significant event in connection with a claim which had an effect on processing and payment?
100
Spell of Illness
What is a period of hospitalization as defined by a health plan.
100
Medicare conditional payment request
What is payment in advance of a primary payers payment when Medicare is the secondary payer and the provider believes the primary payer will not pay promptly.
100
Ancillary Service Revenue Code
What is code used to report services other than the routine room and board that are incidental to the hospital stay.
100
Leave of absence days
What is days when a patient is temporarily released from the hospital.
200
Occurrence Span Code
What is a code that identifies significant events over a span of time which affect tthe processing and payment of the claims.
200
Medical Blood Deductible
What is when a patient must either replace or pay for the first 3 pints of blood used each calendar year
200
All Inclusive Rate
What is a fixed amount charged on a daily basis during a patient's hospitalization or a total rate charged for an entire stay
200
Accomodation revenue code
What is a revenue code that reports a particular bed/accomodation/board charge of a facility
200
Noncovered Days
What is days of inpatient care that is not covered by a patient's primary insurance.
300
Condtion Code
What is a code used to report a special condition or unique circumstance about a claim.
300
72 Hour Rule
What is all out patient diagnostice services performed with in 72 hours of an inpatient addmission becomes part of the inpatient claim. Also known as 72 Hour Window
300
Transitional pass through payments
What is temporary additional reimbursement under APCs for the new drug or other treatments not included in the payment rate
300
Revenue code series
What is the component subcategories of a four digit revenue code that are described using the conventions of an X in the last position.
300
Observation Services
What is Physician ordered care provided to a patient admitted to evaluate a condition or determine a course of treatment
400
Value Code
What is a code reported along with a dollar amount or other unit of measure to provide financial information on the UB-04
400
Working aged person
What is patient or spouse is over 65 and is eligible for group health ins through employment or spouses employment. Medicare is secondary.
400
Conditional Payment
What is payment from Medicare that was requested in advance of a primary payers payment when Medicare is secondary payer and the providers believes the primary payer will not pay promptly.
400
MSP Value Code
What is one of nine value codes and its corresponding amount that indicated the amount paid on behalf of the beneficiary. This is the portion of payment from the primary payer.
400
RAD
What is radiology?
500
HIPPS rate code
What is a code used under PPS associated with skilled nursing facilities, home health providers and inpatient rehabilitation facilities
500
Guarantee of payment provisions
What is policy that Medicare will pay for hospital inpatient services even if the patients benefits were exhausted before the admission (hospital acted in good faith)
500
ABN
What is Advanced Beneficiary Notice of Noncoverage
500
CDM
What is charge description master
500
EMTALA
What is Emergency Medical Treatment and Active Labor Law