Terms : Hide Images
| 3640184447 | Medically Managed | means that even though a diagnosis (e.g., hypertension) may not receive direct treatment during an encounter, the provider has to consider that diagnosis when determining treatment for other conditions. | 0 | |
| 3640189446 | Auditing Process | which involves reviewing patient records and CMS-1500 or UB-04 claims to assess coding accuracy and completeness of documentation. | 1 | |
| 3640194035 | Medicare Coverage Database (MCD) | is used by Medicare administrative con- tractors, providers, and other health care industry professionals to determine whether a procedure or service is reasonable and necessary for the diagnosis or treatment of an illness or injury. | 2 | |
| 3640204757 | Local Coverage Determinations (LCDs) | specify under what clinical circumstances a service is covered (including under what clinical circumstances it is considered to be reasonable and necessary) and coded correctly. | 3 | |
| 3640212725 | Outpatient Code Editor (OCE) | is software that edits outpatient claims submit- ted by hospitals, community mental health centers, comprehensive out-patient rehabilitation facilities, and home health agencies. | 4 | |
| 3640221388 | SOAP Notes | is written in outline format ("SOAP" is an acronym derived from the first letter of the topic headings used in the note: Subjective, Objective, Assessment, and Plan). | 5 | |
| 3640222905 | Subjective | part of the note contains the chief complaint and the patient's description of the presenting problem. | 6 | |
| 3640224575 | Objective | part of the note contains documentation of measurable or objective observations made during physical examination and diagnostic testing | 7 | |
| 3640226316 | Assessment | contains the diagnostic statement and may include the physician's rationale for the diagnosis. | 8 | |
| 3640229820 | Plan | is the statement of the physician's future plans for the work-up and medical management of the case. | 9 | |
| 3640235368 | Operative Reports | will vary from a short narrative description of a minor procedure that is performed in the physician's office to more formal reports dictated by the surgeon in a format required by hospitals and ambulatory surgical centers (ASCs) | 10 | |
| 3640243424 | Optical Character Reader (OCR) | a device used for optical character recognition | 11 | |
| 3640250752 | National Plan and Provider Enumeration System (NPPES) | was developed by CMS to assign the unique health care provider and health plan identifiers and to serve as a database from which to extract data | 12 | |
| 3640253149 | Supervising Physician | is a licensed physician in good standing who, according to state regulations, engages in the direct supervision of nurse practitioners and/or physician assistants whose duties are encompassed by the supervising physician's scope of practice | 13 | |
| 3640258180 | Billing Entity | is the legal business name of the practice | 14 | |
| 3640259865 | Supplemental Plans | usually cover the deductible and copay or coinsurance of a primary health insurance policy. | 15 | |
| 3640268033 | Advance Beneficiary Notice of Noncoverage (ABN) | is a waiver required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program. | 16 | |
| 3640300811 | National Coverage Determinations (NCDs) | on an ongoing basis, and Medicare administrative contractors create edits for NCD rules, called local coverage determinations (LCDs) | 17 | |
| 3640313435 | Narrative Clinic Note | is written in paragraph format | 18 | |
| 3640336113 | Assignment of Benefits | Patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider. | 19 |
