GLOSSARY OF TERMS FOR REIMBURSEMENT AND COMPLIANCE Adjudication: The payer’s act of processing a claim submitted for reimbursement. Adjustment: An amount which is uncollectible by the practice, from either the patient or the insurance company, due to contractual or legal obligations to accept a lower amount as payment in full — and is therefore “written […]

CURRENT HEALTHCARE ACRONYMS AHA: American Hospital Association AHRQ:Agency for Health Care Research and Quality ASC:Ambulatory Surgical Center CAH:Critical Access Hospital CDHC:Consumer Directed Health Care CMI:Case Mix Index CMS:Centers for Medicare & Medicaid Services DRA:Deficit Reduction Act 2005 DRG:Diagnosis Related Group EMR:Electronic Medical Record FFY:Federal Fiscal Year HCAHPS:Hospital Consumer Assessment of Healthcare Providers and Systems HCRIS:Hospital […]

These links go to the CMS website. Medically Unlikely Edits: Main Page Medically Unlikely Edits: NCCI NCCI Edit FAQ Zip files: Practitioner Services MUE Table – Effective 1/1/20 Practitioner Services MUE Table – Effective 10/1/19 Practitioner Services MUE Table – Effective 1/1/19 Facility Outpatient Hospital Services MUE Table – Effective 01-01-2020 (ZIP) DME Supplier Services […]

These two links to CMS are for articles which address Condition 44. Condition 44: MLN Matters SE0622 Condition 44: CMS Manual System: Pub 100-04

This 32 page document is produced by CMS as a reference guide for Physicians and coders. Click to read or download.