| A | B |
|---|
| down-code | insurance carriers down-code if documentation or codes are ambiguous and reimburse for the lowest possible fee |
| modifiers | an additional code that may be added to a five-digit CPT code to further explain the service provided |
| CMS-1500 | formerly known as the HCFA 1500 form that is the office health insurance claims form for Medicare and Medicaid |
| Current Procedural Terminology (CPT) | standard codes for procedures and services. Used by most ambulatory care setting in encoding the claim form and recognized by most insurance carriers |
| E codes | ICD-9-CM codes for the external causes of injury, poisoning, or other adverse reactions that explain how the injury occurred |
| Healthcare Common Procedure Coding System | a coding system consisting of the CPT, national codes (level II) and local codes (level III); previously known as HCFA Common Procedure Coding System |
| International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) | standard diagnosis codes used to identify a patient's medical problem. Used by most ambulatory care setting in encoding the claim form and recognized by most insurance carriers |
| M Codes | found in the ICD-9-CM and used primarily with cancer registries. M codes further identify behavior and the cell type of a neoplasm |
| Uniform Bill 04- (UB-04) | Unique billing form used extensively by acute care facilities for processing inpatient and outpatient claims |
| V codes | ICD-9-CM codes representing either factors that influence a person's health status or legitimate reasons for contacting the health facility when the patient has no definitive diagnosis or active symptom of any disorder |
| Bundled codes | a grouping of several services that are directly related to a specific procedure and are paid as one |
| Claim Register | diary or register of claims submitted to each insurance carrier. When payment is received, the date and amount of payment is entered in the register |
| down-coding | insurance carriers down-code if documentation or codes are ambiguous and reimburse the lowest possible fee |
| Encounter form | formerly known as the charge slip or superbill. A copy of the encounter form is given to the patient after seeing the provider. It identifies the procedures performed, diagnosis's, charges, and when to return |
| point-of-service (POS) device | device allowing direct communication between a medical office and the health care plan's computer |
| unbundling | refers to separating the components of a procedure and reporting them as billable codes with charges to increase reimbursement rates |
| up-coding | also known as code creep, overcoding, and overbilling. Up-coding occurs when the insurance carrier deliberately bills a higher rate service than what was performed to obtain greater reimbursements |
| NEC | Code that is not elsewhere classified and is used and is used if there is not enough information to find a more specific code |
| NOS | Code that is not otherwise specified used when there is absolutely no other code available to fully describe the patient's diagnosis |
| Explanation of Benefits (EOB) | on completion of processing the claim , the insurance company sends this to the insured person. |
| New patient | A patient who has their first visit with a physician or physician group or who was an established patient with a physician or provider but has not been seen in 3 years. |
| NPI | A lifetime number consisting of 10 digits that identifies the provider on medical claims and is unique for each medical provider or group. |
