Shared Flashcard Set

Details

Medical coding terms
terms used in medical coding
28
Insurance
Not Applicable
10/23/2014

Additional Insurance Flashcards

 


 

Cards

Term
APC (Ambulatory Payment Classification)
Definition
a patient classification that provides a payment system for outpatients
Term
CF (Conversion Factor)
Definition
national dollar amount that is applied to all service paid on the Medicare Fee Schedule basis
Term
CMS
Definition
formerly HCFA (Health Care Financing Adminstration
Term
combination Code
Definition
single ICD-9-CM code used to identify etiology and manifestation of a disease
Term
combination coding
Definition
a code from the radiology section as well as a code from one of the other sections must be used to fully describe the procedure
Term
comparative condition
Definition
patient conditions that are documented as “either/or” in the medical record
Term
component coding
Definition
a code from the Radiology section as well as a code from one of the other sections must be used to fully describe the procedure
Term
Constitutional examination element
Definition
assessment of the patient’s general condition and the recording of the vital signs
Term
consultation
Definition
includes those services rendered by a physician whose opinion or advice is requested by another physician or agency concerning the evaluation and/or treatment of a patient; a consultant is not an attending physician.
Term
counseling
Definition
a discussion with a patient and/or family concerning one or more of the following areas: diagnostic results, impressions, and/or recommended diagnostic studies; prognosis; risks and benefits of treatment; instructions for treatment; importance of compliance with treatment; risk factor reduction; and patient and family education
Term
CPT (Current Procedural Terminology)
Definition
a coding system developed by the American Medical Association (AMA) to convert widely accepted, uniform descriptions of medical, surgical, and diagnostic services rendered by health care providers into five-digit codes
Term
critical care
Definition
the area of critically ill patients in attendance of the physician; critical care is usually , but not always, given in a critical care area, such as coronary care unit or the intensive care unit.
Term
DRGs (diagnosis Related Groups)
Definition
a disease classification system that relates the type of inpatients a hospital treats (case mix) to the costs incurred by the hospital
Term
E Codes
Definition
alphanumeric designations preceded by the letter “E” used to classify external causes
Term
Exclusive Provider Organization (EPO)
Definition
similar to a Health Maintenance Organization except that the providers of the services are not prepaid, but rather are paid on a fee-for-service basis
Term
FDA (Food and Drug Administration)
Definition
responsible for the safety of food and drugs in America; an agency within the U.S. Public Health Service, which is part of the Department of Health and Human Services
Term
Federal Register
Definition
official publication of all “President Documents,” “Rules and Regulations,” “Proposed Rules,” and Notices”; government-instituted national changes are published in the Federal Register
Term
Group Practice Model
Definition
an organization of physicians who contract with a Health Maintenance Organization to provide service to the enrollees of the HMO
Term
Grouper
Definition
computer used to input the principal diagnosis and other critical information about a patient and then provide the correct MS-DRG code
Term
Health Maintenance Organization (HMO)
Definition
a health care delivery system in which an enrollee is assigned a primary care physician who manages all the health care needs of the enrollee
Term
MAAC (Maximum Actual Allowable Charge)
Definition
limitation on the total amount that can be charged by physicians who are not participants in Medicare
Term
MAC (Medicare Administrative Contractor)
Definition
an entity that manages the process claims for CMS
Term
Managed Care Organization (MCO)
Definition
a group that is responsible for the health care services offered to an enrolled group of persons
Term
MDC (Major Diagnostic Categories)
Definition
the division of all principal diagnoses into 25 mutually exclusive principal diagnosis areas within the MS-DRG system
Term
Medicare Risk HMO
Definition
a Medicare-funded alternative to the standard Medicare supplemental coverage
Term
MEI (Medicare Economic Index)
Definition
government-mandated index that ties increases in Medicare prevailing charges to economic indicators
Term
MFS (Medicare Fee Schedule)
Definition
schedules that list the allowable charges for Medicare services
Term
MS-DRG (Medicare Severity Diagnosis Related Groups)
Definition
a system classifying patient groups by related diagnosis
Supporting users have an ad free experience!