Facility in which a patient may receive medical care on a
regular basis.
Insurance that is to pay after a primary insurance has paid and
assigned patient responsibility.
The critical examination (as by a physician or nurse) of healthcare services provided to patients especially for the purpose of
controlling costs (as by identifying unnecessary medical
procedures) and monitoring the quality of care.
Month, day and year a person dies.
The United States government's method of paying for facility
outpatient services for the Medicare program
The process of determining which of two or more insurance
policies is primary
Consisting of three digits on a claim used to inform a payer of
the type of services being billed.
Two-digit codes placed on health care professional claims to
indicate the setting in which a service was provided.
This includes details on processing,
billing, patient liability as set forth by the client.
Discount provided to a payer by a provider
The evaluation of the appropriateness and medical necessity of
health care services, procedures, and facilities according to
evidence-based criteria or guidelines, and under the provisions
of an applicable health insurance plan.
Claim number. The unique number applied to a claim during the
processing stages
Present at the time the order for inpatient admission occurs.
Conditions that develop during an outpatient encounter.
An insurance responsible for providing reimbursement for
medical expenses incurred due to an accident. (Ex: auto)
A Medicare beneficiary’s identification number
This system is used by Medicare for claim status or claim corrections
A physician who provides both the first contact for a person with
an undiagnosed health concern as well as continuing care of
varied medical conditions, not limited by cause, organ system,
or diagnosis.
Federal guidelines for protecting a patient’s health information
s Charges incurred through a physician’s visit. Billed on CMS 1500.
The last stage (stage five) of chronic kidney disease
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