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Intentional deception or misrepresentation that an individual knows to be false, result in unauthorized benefits to themselves
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Physician & Healthcare Facilities that render health services
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Intro Medical Coding
Billing & Coding
| Question | Answer |
|---|---|
| Intentional deception or misrepresentation that an individual knows to be false, result in unauthorized benefits to themselves | Fraud |
| Physician & Healthcare Facilities that render health services | Providers |
| Refers to every service listed in the Medicare Physician's Fee Schedule; the same for all physicians as of 1993 | Limiting Charge |
| Adjudication | |
| Composed of numbers and/or letters identifying diagnosis & clinical procedures on claims and encounter forms | Code Sets |
| Patient health record found within a practice management program | Electronic Medical Record |
| This term refers to submitting additional services on a claim that were not performedCo | Upcoding |
| An official publication of all national government changes, especially related to Medicare | Federal Register |
| Reflects physician charges for all procedures provided and/or ordered with offsite facilities | Physician Fee Schedule |
| Used to identify potential discount limit and reflects additional and/or updated procedures | Modifier |
| Considered Hospital Insurance | Medicare Part A |
| Considered Outpatient Insurance | Medicare Part B |
| Formerly considered Medicare + Choice | Medicare Part C |
| Provides prescription drug benefits for Medicare patients | Medicare Part D |
| When was the Medicare Program created | The year of 1965 |
Created by:
dorcia.dunn
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