Term
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Definition
| A REQUIREMENT THAT ALL DIAGNOSTIC OR OUTPATIENT SERVICES FURNISHED IN CONNECTION WITH THE PRINCIPLE ADMITTING DX WITHIN 3 DAYS PRIOR TO THE HOSPITAL ADMISSION ARE BUNDLED WITH THE INPATIENT SERVICES FOR MEDICARE BILLING |
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Term
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Definition
| THE AMERICAN NATIONAL STANDARDS INSTITUTE TRANSACTION FOR AN INSTITUTIONAL CLAIM; AS A RESULTS OF HIPPAA, ITS REPLACING THE ELECTRONIC UB-04 |
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Term
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Definition
| THE AMERICAN NATIONAL STANDARDS INSTITUTE TRANSACTION FOR A PROFESSIONAL CLAIM; IT IS THE ELECTRONIC EQUIVALENT OF THE CMS 1500 |
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Term
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Definition
| SERVICES OTHER THAN ROUTINE ROOM AND BOARD CHARGES THAT ARE INCIDENTAL TO THE HOSPITAL STAY; THEY INCLUDE OPERATING ROOM;ANESTHESIA;BLOOD ADMIN;PHARMACY;RADIOLOGY;LAB;MEDICAL SURGICAL, AND CENTRAL SUPPLIES;PHYSICAL,OCCUPATIONAL,SPEECH PATHOLOGY,AND INHALATION THERAPIES;AND OTHER DIAGNOSTIC SERVICES |
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Term
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Definition
| LEGISLATION WHICH PROVIDES FOR MEDICAL TREATMENT FOR COAL MINERS TOTALLY DISABLED FROM BLACK LUNG DISEASE |
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Term
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Definition
| ALSO KNOWN AS UTILIZATION REVIEW (UR);AN AREA THAT PERFORMS CRITICAL TASKS DURING REGISTRATION AND A PATIENT'S STAY, SUCH AS REDUCING UNNECESSARY ADMISSIONS; MANAGING THE APPROVED LENGTH OF STAY;ENSURING AN APPROPRIATE LEVEL OF CARE FOR THE PATIENTS CONDITION |
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Term
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Definition
| CENTER FOR DISEASE CONTROL AND PREVENTION; ONE OF THE DHHS OPERATION DIVISIONS |
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Term
| CONSUMER CREDIT PROTECTION ACT |
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Definition
| THE FIRST GENERAL FEDERAL CONSUMER PROTECTION LEGISLATION; ITS PROVISIONS INCLUDE THE TRUTH IN LENDING ACT, THE FAIR CREDIT BILLING ACT, THE FAIR CREDIT REPORTING, AND THE FAIR DEBT COLLECTION PRACTICES ACT |
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Term
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Definition
| A TYPE OF DISCHARGE IN WHICH A PATIENTS FINICIAL CONSIDERATIONS HAVE BEEN MET SO HE OR SHE IS ALLOWED TO LEAVE THE HOSPITAL WITHOUT GOING THROUGH THE USUAL FORMALITIES; THE PATIENT IS BILLED AT A LATER DATE |
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Term
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Definition
| A SYSTEM GENERATED, FREE-FORM STATEMENT THAT IS USED TO COMMUNICATE THE STATUS OF A PATIENTS ACCOUNT AND/ OR TO BILL THE PATIENT FOR AN UNPAID AMOUNT REMAINING ON THE ACCOUNT |
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Term
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Definition
| A COURT RULING WHEREBY A BANKRUPTCY IS DISMISSED; THE MOST COMMON REASON FOR DISMISSAL IS FAILURE OF THE DEBTOR TO FOLLOW THROUGH ON THE FILING PROCESS AND ON PAYMENT TO THE ATTORNEY |
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Term
| EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT |
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Definition
| ALSO KNOWN AS THE FEDERAL ANTI-DUMPING |
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Term
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Definition
| FOOD AND DRUG ADMINISTRATION; ONE OF THE DHHS OPERATING DIVISIONS |
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Term
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Definition
| THE HOSPITAL SURVEY AND CONSTRUCTION ACT; ALSO KNOW AS TITLE I |
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Term
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Definition
| COORDINATED, PALLIATIVE CARE PROVIDED TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES BY NONPROFIT ORGANIZATIONS |
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Term
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Definition
| HEALTH MAINTENANCE ORGANIZATION; ONE OF FIVE TYPES OF MEDICARE ADVANTAGE PLANS IN WHICH MEMBERS MUST GENERALLY GET HEALTHCARE FROM PROVIDERS IN THE PLAN'S NETWORK |
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Term
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Definition
| COVERS INPATIENT HOSPITAL STAY, SNF FOLLOWING A 3DAY HOSPITAL STAY, HOME HEALTH CARE, HOSPICE CARE, AND BLOOD |
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Term
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Definition
| COVERS DOCTOR SERVICES, OUTPATIENT HOSPITAL CARE, AND SOME OTHER MEDICAL SERVICES THAT PART A DOES NOT COVER {SUCH AS THE SERVICES OF PHYSICAL AND OCCUPATIONAL THERAPISTS AND SOME HOME HEALTH CARE) |
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Term
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Definition
| ALSO KNOWN AS MEDICARE ADVANTAGE PLANS; MANAGED CARE COVERAGE PROVIDED BY PRIVATE INSURANCE COMPANIES APPROVED BY MEDICARE |
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Term
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Definition
| HELPS PAY FOR PRESCRIPTION DRUGS |
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Term
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Definition
| PREFERRED PROVIDER ORGANIZATION; ONE OF THE 5 TYPES OF MEDICARE ADVANTAGE PLANS IN WHICH MEMBERS CAN SEE ANY DOCTOR OR PROVIDER THAT ACCEPTS MEDICARE AND THEY DONT NEED A REFERRAL TO SEE A SPECIALIST |
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Term
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Definition
| ANOTHER NAME FOR TITLE I OF THE CONSUMER CREDIT PROTECTION ACT, OR TRUTH IN LENDING ACT; IT REQUIRES DISCLOSURE OF INFO BEFORE CREDIT IS EXTENDED |
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Term
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Definition
| SHORT-TERM, TEMPORARY CUSTODIAL CARE THAT ALLOWS A FAMILY MEMBER OR OTHER UNPAID CAREGIVER TO GET RELIEF FROM CARING FOR A PHYSICALLY FRAIL OR DEPENDANT PERSON AT HOME |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| SCHIP - STATE CHILDREN'S HEALTH INSURANCE PROGRAM |
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Term
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Definition
| CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT |
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Term
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Definition
| TAX EQUITY AND FISCAL RESPONSIBILITY ACT |
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Term
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Definition
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Term
| WHAT ARE THE 2 MAIN BODIES EFFECTING HEALTHCARE CHANGE? |
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Definition
DHHS- DEPARTMENT OF HEALTH AND HUMAN SERVICES
CMS- CENTERS FOR MEDICARE AND MEDICAID SERVICES |
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Term
| HOW MANY COMPONENTS OF OIG'S COMPLIANCE PLAN? |
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Definition
7
*WRITTEN POLICIES & PROCEDURES
*DESIGNATED COMPLIANCE OFFICER & COMMITTEE
*EFFECTIVE TRAINING & EDUCATION
*EFFECTIVE LINE OF COMMUNICATION
*ENFORCED STANDARDS/PUBLICIZED DISCIPLINARY PROCEDURES
*AUDITING & MONITORING
*RESPONDING TO OFFENSES/DEVELOPING CORRECTIVE ACTION PLAN |
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Term
| HOW MANY OPERATING DIVISIONS DOES DHHS HAVE? |
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Definition
11
*NIH
*FDA
*CDC
*ATSDR
*IHS
*HSRA
*SAMHSA
*AHRQ
*HCFA
*ACF
*AOA |
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Term
| AN ORIGINAL MEDICARE POLICY NUMBER CONSIST OF WHAT? |
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Definition
| 9 DIGITS AND 1 OR 2 LETTERS |
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Term
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Definition
| HOSPITAL OUTPATIENT ADMIT THRU DISCHARGE |
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Term
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Definition
| HOSPITAL INPATIENT ADMIT THRU DISCHARGE |
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Term
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Definition
| HOSPITAL INPATIENT FIRST INTERIM BILL |
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Term
| CWF - COMMON WORKING FILE CONTAINS INFORMATION REGARDING: |
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Definition
| MEDICARE PATIENT'S ELIGIBILITY AND UTILIZATION DATA |
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Term
| EXAMPLES OF ELECTRONIC BILLING NON-PAPER TRANSFERS ARE: |
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Definition
MANUAL ENTRY
PC DOWNLOAD
TAPE TRANSFER
CPU TO CPU |
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Term
| HOSPITALS THAT ARE EXEMPT FROM THE 72 HOUR RULE ARE: |
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Definition
*PSYCHIATRIC HOSPITALS
*REHABILITATION HOSPITALS
*CHILDREN'S HOSPITALS |
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Term
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Definition
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Term
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Definition
*PRE-ADMISSION
*ADMISSION
*IN-HOUSE
*AT DISCHARGE
*AFTER DISCHARGE |
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Term
| DEERS- DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM IS USED BY TRICARE AND CHAMPUS CONTRACTORS TO OBTAIN INFORMATION REGARDING: |
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Definition
*NON-AVAILABILITY DATA
*CONFIRM ELIGIBILITY |
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Term
| BASIC INFORMATION COLLECTED AT REGISTRATION ARE: |
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Definition
*DEMOGRAPHIC
*FINANCIAL/LEGAL
* SOCIO-ECONOMIC
*CLERICAL
*CLINICAL |
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Term
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Definition
| THE ESTIMATED PORTION OF THE PATIENT'S BILL NOT COVERED BY INSURANCE. PAYMENT CAN BE MADE IN ONE INSTALLMENT OR FINANCED OVER TIME AND CAN BE COLLECTED PRIOR TO ADMISSION OR AT TIME OF DISCHARGE |
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Term
| WHAT DOES A GENERAL CONSENT FORM COVER: |
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Definition
*BLOOD TRANSFUSIONS
*ROUTINE LAB TESTING
*DIAGNOSTIC RADIOLOGY
*MEDICAL TREATMENT |
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Term
| ACTUAL OR EXPRESSED CONSENT:WRITTEN OR ORAL |
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Definition
| PATIENT AGREES TO TREATMENT OUTLINED |
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Term
| IMPLIED CONSENT-IN FACT:CONSENT BY SILENCE |
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Definition
| CONSENT IMPLIED BY NOT OBJECTING |
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Term
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Definition
| PATIENT IS UNCONSCIOUS & TAKEN TO ER STATE ALLOWS TREATMENT |
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Term
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Definition
| PATIENT UNDERSTANDS WHAT HE/SHE IS BEING TREATED FOR & THE PROCEDURES |
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Term
| JCAHO - THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS: |
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Definition
| CONDUCTS AN AUDIT ON HOSPITALS EVERY 3YRS, REQUIRES HOSPITALS TO HAVE WIDE DISASTER PLANS...RESPONSE, BACK-UP, RECOVERY |
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Term
| A PATIENT ACCOUNT MAY BE FORWARDED TO A THIRD PARTY COLLECTIONS AT ANY TIME AS LONG AS THERE IS A VALID & DOCUMENTED SERVICE? TRUE OR FALSE |
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Definition
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Term
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Definition
| LEGALLY VERIFIED CLAIM AGAINST A DEBTOR |
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Term
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Definition
| FOR INJURY DONE BY ONE PERSON TO ANOTHER |
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Term
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Definition
| RECORDED CLAIM AGAINST REAL OR PERSONAL PROPERTY |
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Term
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Definition
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Term
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Definition
| AVOID TO PAY BILLS BY CHANGING RESIDENCY AND NOT LEAVING A FORWARD ADDRESS OR PURPOSELY CHANGE THEIR NAME OR GIVES INTENTIONAL FALSE INFO |
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Term
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Definition
| PATIENT MOVES BUT DOES NOT NOTIFY CREDITORS...A FORWARD ADDRESS IS NORMALLY ON FILE |
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Term
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Definition
| CLERICAL ERROR AT TIME OF REGISTRATION...TRANSPOSED NUMBERS IN THE STREET ADDRESS OR INCORRECT ZIP & INCOMPLETE INFO |
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Term
| WHAT IS EXEMPT FROM APC'S |
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Definition
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Term
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Definition
*PRIME-MTF'S ARE THE PRINCIPAL SOURCE OF HEALTH CARE
*EXTRA- A PREFERRED PROVIDER OPTION THAT SAVES MONEY
*STANDARD- A FEE FOR SERVICE OPTION (THE OLD CHAMPUS PROGRAM) |
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Term
| MEDICAL SPELL OF ILLNESS AKA: |
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Definition
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