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**Common Terms and Definitions**

Across
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.
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.
The translation of written descriptions of diseases, illnesses and injuries
Federal guidelines for protecting a patient’s health information
A federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program
Insurance that is to pay after a primary insurance has paid and assigned patient responsibility.
Present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter.
Any and all duties that each party is legally responsible for in a contractual agreement.
The last stage (stage five) of chronic kidney disease
r A unique number assigned to a claim after it has been processed. Also called a claim number. This could also be applied to appeals or other documentation related to the claim.
Inpatient claims are paid according to the....
Insurance that is to pay after primary and secondary insurances has paid and assigned patient responsibility.
The practice of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care. Houses medical records.
Month, day and year a person dies.
Drugs that are taken on one’s own. Not injectable IV solutions or treatments. (Ex: Tylenol)
An insurance responsible for providing reimbursement for medical expenses incurred due to an accident. (Ex: auto)
Month, day and year a person is born.
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.
Down
This includes details on processing, billing, patient liability as set forth by the client.
Any information about health status, provision of health care, or payment for health care that is created or collected by a "Covered Entity" (or a Business Associate of a Covered Entity), and can be linked to a specific individual
Claim number. The unique number applied to a claim during the processing stages
Discount provided to a payer by a provider
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
Month, day and year a patient is seen within a hospital or by a physician.
A Medicare beneficiary’s identification number
Money owed to a hospital by insurance and/or patients.
Facility in which a patient may receive medical care on a regular basis.
The second-largest insurance company.
A five digit unique number assigned to each individual physician and hospital. This is used to contact Medicare.
s Charges incurred through a physician’s visit. Billed on CMS 1500.
Consisting of three digits on a claim used to inform a payer of the type of services being billed.
Similar to a deductible; the amount to be paid out-of-pocket by a patient prior to Medicaid providing payment for services.
This system is used by Medicare for claim status or claim corrections
Documentation provided by a hospital or physician’s office to alert a patient to the possibility of non-covered services which will be patient responsibility.
Two-digit codes placed on health care professional claims to indicate the setting in which a service was provided.