MedicalManager
Terms
undefined, object
copy deck
- 3rd party
- usually refers to the patient's insurance company
- ABN
- Advance Beneficiary Notice- CMS required notice signed by patient that Medicare service could be denied and become patient responsibility
- ADA
- American Dental Association
- adjustments
- correcting the amount of the bill
- ages accounts receivable
- listing of how long each account has been due- how long over due
- ailment detail
- info about illness or injury required by insurance company, especially workman's comp.
- ASA
- American Society of Anesthesiologists
- ASA Guide
- guidelines for anesthesia services and procedures
- assignment of claim
- designates who will receive payment from insurance company
- auto pay
- method of automatically allocating payment to several open items
- balance due
- amount payable at the time of the billing
- batch
- group of charges or payments posted in one session
- beneficiary
- recipient of Medicare benefits (or life insurance benefits)
- Birthday Rule
- when there is dual insurance coverage. Month and day of birth determines primary carrier
- catastrophic illness
- lengthy and serious illness or injury causing costs to exceed a percent of annual income or public assistance levels
- CDT
- Current Dental Terminology
- CDT-3
- Current Dental Terminology 3rd edition, dental coding manual
- CMPL
- Civil Monetary Penalty Law, penalties, fines, sanctions for fraud/abuse
- CMS-1500
- health insurance claim form
- co-payment
- a per-visit amount which is the patient's responsibility per their contract.
- COB
- coordination of benefits, two insurance companies share payment responsibility
- Concurrent care
- in the hospital- 2 physicians of different specialties treating a patient with 2 distinctly separate conditions at the same time
- CPT-4
- procedure coding system "what was done"
- CRNA
- Certified Registered Nurse Anesthetist
- daily report
- detail of all transactions posted during that day
- deductible
- annual amount in the patient contract which is patient responsibility
- default responses
- information appearing automatically when you press enter
- DME
- durable medical equipment
- DOS
- Date of service
- downcoding
- reporting a reduced level of service
- DRG
- Diagnosis Related Group, hospital reimbursement system
- EDI
- electronic data interchange for electronic claims submission
- edits
- electronic or manual claims screening process mainly Medicare
- elective procedure
- non emergent or noncritical procedure, scheduled at convenience
- encounter form
- list of charges, payments, procedures, and treatments during a visit.
- EOB
- Explaination of benefits
- EOMB
- Explaination of Medicare benefits
- EPSDT
- early periodic screening, diagnosis and treatment, children age 12 or less; Medicaid program
- established patient
- seen within 3 years by provider or an associate, same office/practice
- F1 key
- processes information in The Medical Manager
- fatal error
- way of informing you that the program has found a damaged record (write down error message and contact instructor.)
- field
- location of specific pieces of information keyed into the computer
- fill
- an insurance contract designed to go with the Medicare program
- FUD
- follow up days, in a global surgical package
- general ledger
- a general record to which debits and credits are posted
- global fee
- one price for an all inclusive package of services
- group practice
- providers operating under the same tax ID #, same organization
- guarantor
- person responsible for paying the bill.
- HMO
- Health Maintenance Organization, managed care
- hosipital based physician
- an employee of the hospital, on the hospital payroll
- hospital rounds
- visits by a physician to patients in the hospital
- HPSA
- health personnel shortage area
- ICD-9
- diagnosis coding system "why something was done" (International Classification of Disease 9th edition)
- ID #
- identification number
- insurance billing worksheet
- report preview of charges to be sent to the insurance company
- insurance plan
- name of insurance company to which claims are sent
- Medicaid
- health insurance for medically indigent run by the states, uses federal funds
- Medicare
- Federal insurance for those who are over age 65 and the disabled
- NPDB
- National provider data bank, database, maintains info regarding malpractice litigation or claim judgement, suspension or revocation of license, actions taken by hospital boards, HMO, peer review or professional society against a physician, nationally
- NPI
- National provider identifier, number given by a provider by CMS to provide control over other providers, suppliers in the Medicare program.
- open items
- charges posted previously but not yet paid in full
- patient statement
- bill sent to patient, usually monthly
- PC
- Previous century-relates to entering patient's date of birth
- period purge
- a removal of specified items from specific records or accounts
- policy #
- the ID number assigned to a specific insurance policy
- posting
- keying information into an account- payments, credits, adjustments
- PPRC
- Physician Payment Review Committee, committee to make recommendations for Medicare reform
- pre-existing condition
- condition or situation that occurred/existed prior to effective date of insurance coverage
- primary insurance
- insurance company with the first responsibility to pay the bill.
- PRO
- Peer review organization, compares physician practice with their peers
- procedure
- service performed by the doctor
- Provider
- one who provides a service
- Provider #
- ID number assigned to a provider by an insurance company for their records
- Retrospective Review
- review of service after treatment has been rendered
- secondary insurance
- insurance company that has a supplemental responsibility to pay (pays second)
- service facility
- place where treatment was performed
- subrogation
- determines who is responsible for payment of cliam when there are multiple insurances and recovers money paid from the insurance company that has actual resposibility for the case
- system summary worksheet
- financial report with period-to-date, year-to-date totals
- unbundling
- separately reporting procedures included in the primary procedure code
- upcoding
- reporting a higher level of service than delivered (fraud/abuse)
- UPIN
- Unique Provider Identification Number, number assigned by Medicare carrier to providers practicing in their jurisdiction
- UPIN #
- Universal Provider Identification Number assigned to a provider
- UR
- utilization review
- voucher
- record of payment processing
- voucher field
- in Medical Manager, the area in which you enter the payment check number
- work in form
- blank encounter form completed by hand and attached to patient chart
- write-off
- deducting a specific amount from the billing