Health Insurance - Ch 11 (Essential CMS-1500 Claim Instructions)
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12 terms
Terms | Definitions |
|---|---|
 Billing Entity | ... |
| Diagnosis Pointer Number | ... |
| Medically Unlikely Edits (MUE) Project | ... |
| Medigap | ... |
| National Plan and Provider Enumeration System (NPPES) | Developed by CMS to assign the unique healtcare provider and health plan identifiers and to serve as a database from which to extract data (e.g., health plan verification of provider NPI). |
| Optical Character Reader (OCR) | A device used for optical character recognition. |
| Optical Scanning | Uses a device (scanner) to convert printed or handwritten characters into text that can be viewed by an optical character reader (OCR) |
| Supplemental Plan | ... |
| Observation Care | A well-defined set of specific, clinically appropriate services, which include ongoing short-term treatmnet, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. |
| Direct Admission | Occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department. (ED) |
| Nonphysician Practitioner (NPP) | e.g., nurse practitioner, physician assistant |
| POS | Place of service on CMS-1500 (Appendix II) |
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