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CH. 6 EHR reimburse
Ch. 6 -EHR Reimbursement
| Term | Definition |
|---|---|
| abstracting | Collecting data from a health record. Used for determining CPT, HCPCS, or ICD-10-CM codes and for release of information. |
| abuse | Unintentional deception in which a provider inappropriately bills for services that are not medically necessary, do not meet current standards of care, or are not medically sound. |
| coding variance | Medical coding mistakes caused by computer error or by various kinds of human error, from simple carelessness to incorrect application of coding guidelines and procedures. |
| compliance plan | written set of office policies and procedures intended to ensure compliance with laws regulating billing, coding, and third-party reimbursement. |
| CPT (Current Procedural Terminology) | comprehensive set of medical codes that describe procedures, treatments, and services for financial reimbursement and analytical purposes |
| eligibility | Entitled to receive benefits from a health plan. |
| encounter form | form generated to reflect the services and charges for a patient visit. It includes patient information and account balance. This may also be referred to as a Superbill. |
| fraud | Presenting claims for services that an individual or entity knows or should know to be false, resulting in a benefit to the presenting party. |
| guarantor | person who is legally responsible for a patient’s account; the guarantor is usually the patient, but the guarantor for a minor or a person of decreased mental capacity may be a parent, trustee, or legal guardian. |
| HIPAA 5010 | standard electronic claim format used by a non-institutional provider or supplier to submit a claim electronically to Medicare and most other insurance carriers for covered services. |
| ICD-10-CM | International Classification of Diseases, Tenth Revision, with Clinical Modification. A coding system used to describe inpatient and outpatient diagnoses. |
| medical coding | process of assigning standard numeric or alphanumeric codes to diagnoses, procedures, and treatments for research, disease tracking, and reimbursement purposes |
| medical identity theft | unauthorized use of someone else’s personal information to obtain medical services or to submit fraudulent medical insurance claims for reimbursement. |
| pay for performance (P4P) | outcomes-based payment model that offers providers financial incentives for meeting specific standards and electronically documenting compliance with them; punitive measures may be applied to providers who fail to comply. |
| third-party payer | organization, other than the patient, that pays for the incurred medical expenses. This could be a federal program or a commercial insurance company (for example, Medicare, Medicaid, Blue Cross and Blue Shield, and Humana). |
Created by:
chaisenpai
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