WK6H76X9GQZV
Adjustment Correction to an incorrectly paid claim, which would result in a partial refund to Medicaid or additional payment to the provider
Adult Health Screening
A service provided to assess the health status of recipients age 21 and older in order to detect and prevent disease, disability, and other health conditions or monitor their progression.
Beneficiaries
Persons receiving medical benefits under Medicare. Persons eligible for Medicaid are also sometimes referred to as beneficiaries
Billing Agent
A billing agent is an entity that offers claims submission services to providers. Providers may submit claims themselves or choose to have a billing agent. Billing agents must be enrolled in the Medicaid program.
Centers for Medicare and Medicaid Services (CMS)
Formerly known as the Health Care Financing Administration (HCFA), this federal agency within the
Department of Health and Human Services is responsible for the regulation of the various states’ Medicaid programs. Also known as CMS.
Children’s Medical Services (CMS)
Children’s Medical Services is a division of the Florida Department of Health that provides children with special health care needs with a family centered, managed system of care through the CMS Network. Children with special health care needs are those children under age 21 whose serious or chronic
physical or developmental conditions require extensive preventive and maintenance care beyond that required by typically healthy children.
Child Health Check-Up
Child Health Check-Up, formerly named Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), is a comprehensive, preventive childhealth screening program. Referrals are made to other providers for treatment when indicated.
Claim A request for Medicaid to pay for health care services.
CLIA “CLIA” stands for the Clinical Laboratory Improvement Amendments of 1988.
CLIA prescribes nationwide quality assurance standards applicable to all laboratory facilities that examine materials from the human body for the diagnosis or treatment of disease or for the assessment of health.
Concurrent Days The days when a Medicaid recipient and her newborn(s) are inpatients of the same hospital at the same time.
Cosmetic Surgery A surgical procedure for aesthetic purposes only.
Crossover Claim Medicare crossover claims are claims that have been approved for payment by Medicare and sent to Medicaid for the payment of the Medicare deductible and coinsurance within the Medicaid program limits
Deny To refuse to pay a claim as submitted.
Disease Management Organization (DMO)
Disease management organizations are private vendors who provide disease management services to Medicaid recipients enrolled in the Primary Care Case Management Program (MediPass) who have been diagnosed with certain chronic diseases, such as diabetes, HIV/AIDS, asthma, and hemophilia
Durable Medical Equipment (DME)
Equipment that can withstand repeated use, serves a medical purpose, and is appropriate for use in the recipient’s home.
Dx Code Diagnosis code as found in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
EOMB Explanation of Medicaid or Medicare Benefits
EPSDT Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), is now named Child Health Check-Up.
Established Patient A recipient who is known to the center, office, or provider or whose records are normally available. For physicians, an established patient is an individual who has received professional services from the provider or another provider with the same specialty who belongs to the same provider group, within the past three years.
Examination A personal, face-to-face contact with a Medicaid recipient during the process of inspection or investigation inherent to the diagnosis and treatment of any disease, complaint, or disorder by a physician or persons under the direct supervision of a physician.
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
Background: Type of Service (TOS) is an indicator that the contractor places on the Form CMS-1500 paper form or electronic format. The indic...

No comments:
Post a Comment