Medical Billing & Coding Module 6 Flashcards

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