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BNC 101 Chapter 7 Ins Vocab

H Wydler

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8.computerized Medicare system that prevents overpayments (3 Words)
10.OIG's annual list of planned projects (3 Words)
11.setting fees by comparing usual fees, customary fees, and reasonable fees
12.audit conducted by an outside organization (2 Words)
13.periodic prepayment to a provider for specified services to each member (2 Words)
14.program designed to audit Medicare claims (3 Words)
16.reporting undocumented services the coder assumes have been provided due to the nature of the case or condition (2 Words)
17.providing free services to other physicians (2 Words)
20.individuals or companies not permitted to participate in federal health care programs (2 Words)
21.collecting the difference between a provider's usual fee and a payer's lower allowed charge (2 Words)
22.list of a practice's frequently reported procedures and diagnoses (3 Words)
23.system of assigning unit values to medical services based on their required skill and time (3 Words)
25.maximum charge a plan pays for a service or procedure (2 Words)
26.computerized system that identifies improper or incorrect
1.units of service edits used to lower the Medicare fee-for-service paid claims error rate (3 Words)
2.amount used to multiply a relative value unit to arrive at a charge (2 Words)
3.connection between a service and a patient's condition or illness (2 Words)
4.both services represented by MEC codes that could not have been done during one encounter (4 Words)
5.number showing if the use of a modifier can bypass a CCI edit (3 Words)
6.to deduct an amount from a patient's account (2 Words)
7.medicare factor used to adjust providers' fees in a particular geopgraphic area (abbr)
9.diagnoses not coded to the highest level of specificity (2 Words)
15.factor assigned to a medical service based on the relative skill and required time (3 Words)
18.self-audit conducted by a staff member or consultant (2 Words)
19.payer's review and reduction of a procedure code
23.relative value scale for establishing Medicare charges (abbr)
24.methodical formal examination or review

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