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Medically Unlikely Edit
A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. Claim edits compare different values on medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. MUE are designed to limit fraud and/or coding errors. They represent an upper limit that unquestionably requires further documentation to support. The ideal MUE is the maximum unit of service for a code on the majority of medical claims. MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The NCCI policies are based on coding conventions by nationally recognized organizations and are updated annually or quarterly. History Medically Unlikely Edits began in January 2007 they are generally based on biological considerations, like number of limbs or organs. They adjudicate o ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Centers For Medicare And Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States. This includes maintaini ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Claim (medical)
Claim may refer to: * Claim (legal) * Claim of Right Act 1689 * Claims-based identity * Claim (philosophy) * Land claim * A ''main contention'', see conclusion of law * Patent claim * The assertion of a proposition; see Douglas N. Walton * A right * Sequent, in mathematics * Another term for an advertising slogan **Health claim * A term in contract bridge * king of claim (Indonesia) Entertainment * ''The Claim'', a 2000 British-Canadian Western romance film * The Claim (band), a British band See also * "Claimed "Claimed" is the eleventh episode of the The Walking Dead (season 4), fourth season of the Apocalyptic and post-apocalyptic fiction, post-apocalyptic Horror fiction, horror television series ''The Walking Dead (TV series), The Walking Dead'', wh ...", an episode of the television series ''The Walking Dead'' * Reclaim (other) {{disambig ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medical Billing (United States)
Medical billing is a payment practice within the United States healthcare system. The process involves a healthcare provider obtaining insurance information from a patient and filing, following up on and appealing claims with health insurance companies in order to receive payment for services rendered, such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs. Medical coding reports what the diagnosis and treatment were and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Procedure Codes
Procedure codes are a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The structure of the codes will depend on the classification; for example some use a numerical system, others alphanumeric. Examples of procedure codes International * International Classification of Primary Care (ICPC-2), as well as procedure codes; ICPC-2 also contains diagnosis codes, reasons for encounter (RFE), and process of care. * International Classification of Procedures in Medicine (ICPM) and International Classification of Health Interventions (ICHI) * SNOMED CT North American * Canadian Classification of Health Interventions (CCI) (used in Canada. Replaced CCP.) * Current Dental Terminology (CDT) * Healthcare Common Procedure Coding System (including Current Procedural Terminology) (for outpatient use; used in United States) * ICD-10 Procedure Coding System (ICD-10-PCS) (for inpatient use; used in United States) * ICD-9-CM Volume 3 ( ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Care Provider
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive payments for their services rendered from health insurance providers. In the United States, the Department of Health and Human Services defines a health care provider as any "person or organization who furnishes, bills, or is paid for health care in the normal course of business." Individual providers In the United States, the law defines a healthcare provider as a "doctor of medicine or osteopathy who is authorized to practice medicine or surgery" by the state, or anyone else designated by the United States Secretary of Labor as being able to provide health care services. In general, this is seen to include: * Physician, a professional who practices medicine * Advanced practice provider, a trained health worker who has a defined scope ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Patient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider. Etymology The word patient originally meant 'one who suffers'. This English noun comes from the Latin word ', the present participle of the deponent verb, ', meaning 'I am suffering,' and akin to the Greek verb (', to suffer) and its cognate noun (). This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care. Outpatients and inpatients An outpatient (or out-patient) is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) is a Centers for Medicare & Medicaid Services (CMS) program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits: * Physician Edits: these code pair edits apply to physicians, non-physician practitioners, and Ambulatory Surgery Centers * Hospital Outpatient Prospective Payment System Edits (Outpatient Edits): these edits apply to the following types of bills: Hospitals (12X and 13X), Skilled Nursing Facilities (22X and 23X), Home Health Agencies Part B (34X), Outpatient Physical Therapy and Speech Language Pathology Providers (74X), and Comprehensive Outpatient Rehabilitation Facilities (75X). Both the physician and outpatient edits can be split into two further code pair categories: * Column1/Column2 Code Pairs: these code pairs were created to identify unbundled services. The name is derived from the fact that the code pairs are separated into two columns; Colu ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
American College Of Radiation Oncology
American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the " United States" or "America" ** Americans, citizens and nationals of the United States of America ** American ancestry, people who self-identify their ancestry as "American" ** American English, the set of varieties of the English language native to the United States ** Native Americans in the United States, indigenous peoples of the United States * American, something of, from, or related to the Americas, also known as "America" ** Indigenous peoples of the Americas * American (word), for analysis and history of the meanings in various contexts Organizations * American Airlines, U.S.-based airline headquartered in Fort Worth, Texas * American Athletic Conference, an American college athletic conference * American Recordings (record label), a record label previously known as Def American * American University, in Washington, D.C. Sports teams Soc ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
American College Of Physicians
The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved October 20, 2014 With 161,000 members, ACP is the largest medical-specialty organization and second-largest physician group in the United States, after the American Medical Association.Osmosis "Prep for the Medicine Shelf". Retrieved October 20, 2014 Its flagship journal, the ''Annals of Internal Medicine'', is considered one of the five top medical journals in the United States and Britain. Mission and history Founded in 1915, ACP's stated mission is to "enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine." In 1998, it merged with the American Society of Internal Medicine (ASIM). ASIM's focus on the economic, political, and social aspects of medical care both enlarged and complemented its mission. Known as ACP-ASIM from ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
American Society Of Clinical Oncology
The American Society of Clinical Oncology (ASCO) is a professional organization representing physicians of all oncology sub-specialties who care for people with cancer. Founded in 1964 by Fred Ansfield, Harry Bisel, Herman Freckman, Arnoldus Goudsmit, Robert Talley, William Wilson, and Jane C. Wright, it has nearly 45,000 members worldwide. Physician education ASCO offers educational resources for cancer physicians and other health care professionals of clinical oncology. These include scientific meetings, educational conferences, professional workshops, and special symposia on issues of particular relevance and importance to oncologists and researchers. It also produced the patient information website, Cancer.Net. It publishes numerous journals, books, newsletters, and online and multimedia resources; it publishes the ''Journal of Clinical Oncology The ''Journal of Clinical Oncology'' is a peer-reviewed medical journal published 3 times a month by the Lippincott Williams ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's stated mission is "to promote the art and science of medicine and the betterment of public health." The Association also publishes the ''Journal of the American Medical Association'' (JAMA). The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties. The American Medical Association is governed by a House of Delegates as well as a board of trustees in addition to executive management. The organization maintains the AMA Code of Medical Ethics, and the AMA Physician Masterfile containing data on United States Physicians. The ''Current Procedural Terminology'' coding system was first published in 1966 and is maintained by the Association. It has also publi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
