Chapter 6 Health Information Technology: An Applied Approach

accept assignment
a term used to refer to a provider’s or a supplier’s acceptance of the allowed charges (from a fee schedule) as payment in full for services or materials provided
account receivable
records of the payments owed to the organization by outside entities such as third party payers and patients
administrative services only (ASO) contracts
an agreement between an employer and an insurance organiztion to adminster the employer’s self-insured health plan
Advance Beneficiary Notice of Noncoverage (ABN)
a statement signed by the patient when he or she is notified by the provider, prior to a service or procedure being done, that Medicare may not reimbure the provider for the service, wherein the patient indicates that he will be responsible for any charges
all patient DRGs (AP-DRGs)
a case mix system developed by 3M and used in a number of state reimbursement systems to classify non-Medicare discharges for reimbursement purposes
all patient refined DRGs (APR-DRGs)
a case mix system develped by 3M and sued in a number of state reimbursement systesm to classify non-Medicare discharges for reimbursement purposes
ambulatory payment classification (APC) system
hospital outpatient prospective payment system (HOPPS) syste. within a group, the diagnoses and procedures are similar in tersm of resources used, complexity of illness and conditions represented. a singel payment is made for the outpatient services provided.
ambulatory surgery center (ASC)
under Medicare, it is a facility that has its own national identifier; is a separate entity with respect to its licensure, accreditation, governance, professional supervision, administrative functions, clinical services, recordkeeping, and financial and accoutnig systems. ahs as its sole purpose the provision of services in connection with surgical procedures that do not require inpatient hospitalization; and meets the conditions and requirements set forth in the Medicare Conditions of Participation
auditing
the performance of internal and/or external reviews to identify variations from established baselines
balance billing
a reinbursment method that allows providers to bill patients for charges in exces of the amount paid by the patients’ health plan or other third party payer
balanced budget refinement act of 1999 (BBRA)
the amended version of the Balanced Budget Act of 1997 that authorizes implementatino of a per discharge prospective payment system for care provided to Medicare beneficiaries by inpatient rehabilitation facilities
blue cross and blue shield (BC/BS)
the first prepaid healthcare plans in the United States;
BC/BS federal employee program (FEP)
a federal program that offers a fee for service plan with preferred provider organizations and a point of service product
bundled payments
a category of payments made as lump sums to providers for all healthcare services delivered to a patient for a specific illness and/or over a specified time periodl. they include multiple services and may include multiple providers of care.
capitation
…a method of healthcare reimbursement in which an insurance carrier prepays a physician, hospital, or other healthcare provider a fixed amount for a given population without regard to the actual number or nature of healthcare services provided to the population
case mix group
…the 97 function related groups into which inpatient rehabilitation facility discharges are classifed on the basis of the patient’s level of impairment, age, comorbidities, functional ability, and other factors
case mix group (CMG) relative weights
…factors that ccount fo rhte variance incost per discharge and resource utuilization among case mix groups
case mix index
…the average relative weight of all cases treated at a given facility ior by a given physician, which reflects the recource intensity or clinical severity fo a specific group in relation to the other groups int eh classification system; calculated by dividing the sum of the weights of diagnosis related groups for patients discharged during a given period divided by the total number of patients discharged
categorically needy eligibility groups (Medicaid
…categories of individuals to whom states must provide coverage under the federal Medicaid program
centers for Medicare and Medcaid services (CMS)
…the division of the Department of Health and Human Services that is responsible for developing healthcare policy in the United States and for administereing the Medicare program and the federal port5ion of the Medicaid program
chargemaster
…a financial manager form that contains information about the organization’s charges for the healthcare services it provides to patients
civilian health andmedical program of teh uniformed services (CHAMPUS)
…a federal program providing supplementary civilian sector hospital and medical services beyond that which is available in military treatment facilities to military dependents, retirees, and their dependents, and certain other.
civilian health and medical program veterans affairs (CHAMPVA)
the federal healthcare benefits program for dependents of veteran rated by th eVeterans Administration as having a total and permanent disability, fo rsurvivors of veterans who died from VA-rated service connected conditions or who were rated permanently and toatlly disabled at the time of death from a VA rated service connected condition, and for survivors of persons who died in the line of duty
claim
…itemized statement of heatlhcare services and their costs provided by a hospital, physician’s office, or other healthcare provider; submitted for reimbursement to the healthcare insurance plan by either the insured party or by the provider
CMS-1500
…the universal insurance claim form developed and approved by the American Medical Association and teh Centers for Medicare and Medicaid Services; physicians use it to bill Medicare, Medicaid, and private insurers for services provided
coinsurance
cost sharing in which the policy or certificate holder pays a preestablished percentage of eligible expenses after the deductible has been met
comorbidity
a medical condition that coexists with the priamry cause for hospitalization an daffects the patient’s treatment and length of stay
compliance
…the process of establishing an organizational culture that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal, state, or private payer healthcare program requirements or thehealthcare organization’s ehtical and business policies 2. the act of adhering to oficial requirements
compliance program guidance
…the information provided by the Office of the Inspector General fo the Department of Health and Human Services to help healthcare organizations develop internal controls that promote adherence to applicable federal and state guidelines
complication
a medical condition that arises during an inpatient hospitalization
coordination of benefits (COB) transaction
…the electronic transmission of claims and /or payment information from a healthcare provider to a health plan for the purpose fo determining relative payment responsibilities
cost outlier
exceptionally high costs associated with inpatient care when compared with other cases in teh same diagnosis related group
cost outlier adjustment
additional reimbursement for certain high cost home care cases boased on teh loss sharing ratio of costs in excess of a threshold amount for each homoe health resource group
current procedural terminology (CPT)
…a comprehensive, descriptive list of terms and numeric codes used for reporting diagnostic and therapeutic procedures and other medical services performed by physicians; published and jupdated annually by teh Americna Medical Association
department of health and human services (HHS)
…the cabinet level federal agnecy that oversees all fo the health and human services related activities of the federal government and adminsters federal regulations
diagnosis related groups (DRGs)
…a unit of case mix clasifications adopted by the federal government and some other payers as a prospective payment mechanism for hospital inpatients in which diseases aer placed into groups because realted diseases and treatments ten to consume similar amounts of heatlhcare resources and incur similar amounts of cost; in the Medicare and Medicaid programs, one of the more than 500 diagnostic classifications in which cases demonstrate similar resource consumption and lenght of stay patterms
discharge planning
…the process of coordinating the activites related to the release of a pateitn when inpatient hospital care is no longer needed
discounting
the application of lower rates of payment to multiple surgical procedures performed during the same operative session under the outpatient prospective payment system; the application of adjusted rates of payment by preferred provider organizations
DRG grouper
…a computer program that assigns inpatient cases to diagnosis-related groups an ddetermines the Medicare reimbursement rate
employer based self insurance
…an umbrell term used to describe health plans that are funded directly by employers to provide coverage for their employees exclusively in which employers establish accounts to cover their employees’ medical expenses and retain control over the funds but vear teh risk of paying claims greater than their estimates
episode of care (EOC) reimbursement
…a category of payments mae as lump sums to providers for all healthcare services delivered to a patient for a specific illness and/or over a specified time period;
exclusive provider organization (EPO)
…hybrid managed care organization that provides benefits to subscribers only when healthcare services are performed by network providers; sponsored by self-insured (self-funded) employers or associations and exhibits characteristics of both health maintenance organizations and preferred provider organizations
explanation of benefits (EOB)
…a statement issued to the insured and the healthcare provider by an insurer to explain the services provided, amounts billed, and payments made by a health plan
external reviews (audits)
…a performance or quality reivew conducted by a third-party payer or consultant hired for the purpose
federal employees’ compensation act (FECA)
…the legistlation enacted in 1916 to mandate workers’ compensation for civilian federal employees, whose coverage includes lost wages, medical expenses, and survivors’ benefits
fee schedule
…a list of healthcare services and procedures (usually CPT/HCPCS codes) and the charges associated with them develpoed by a third party payer to represent the approved payment levels for a gien insurance plan; also called table of allowances
fee for service basis
…a method of reimbursment through which providers retrospectively receive payment based oneither billed charges for servicers provided or on an annually updated fee schedule
fraud and abuse
…the intentional and mistaken misrepresentation of reimbursement claims submitted to government sponsored health programs
geographic practice cost index (GPCI)
…an index developed by the Centers for Medicare and Medicaid Services to measure the differences in resource costs among fee schedule areas compared to thenational average in teh three componenets of the relative value unit; physican work, practice expenses, and malpractice coverage.
global payment
…a form of reimbursmeent used for radiological and other procedures that ocmbines teh professional an dtechnical components of the procedures and disperses payments as lump sums to be distributed between the physician and the healthcare facility
global surgery payment
…a payment made for surgical procedures that includes the provision of all healthcare servicesw, from the treatment decision through postoperatie patient care
group health insurance
…a prepaid medical plan that covers thehealthcare expenses of an organization’s full time employees
group model HMO
…a type of health plan in which an HMO contracts with an independent multispecialty physician group to provide medical services to members of the plan
group pracitce without walls (GPWW)
…a type of managed care contract that allows physicians to maintain their own offices and share adminstyrative services
hard coding
…the process of attaching a CPT/HCPCS code to a procedure located on teh facility’s chargemaster so that the code will automatically be included ont he patient’s bill
health maintenance organization (HMO)
…entity that combines teh provision of healthcare insurance and the delivery of healthcare services, characterized by : 1. an organized healthcare delivery system to a geographic area, 2. a set of basic and supplemental health maintenance and treatment services, 3. voluntarily enrolled members, and 4. predetermined fixed, periodic prepayments for members’ coverage
healthcare common procedure coding system (HCPCS)
…an alphanumeric classification system that identifies healthcare procedures, equipment, and supplies for claim submissionpurposes; the three levels are as follows I, Current Procedural Terminology coes, developed by the AMA; II, codes for equipment, supplies, and services not covered by Current Procedural Terminolgoy codes as well as modifiers, that can be used with all levels of codes, developed by CMS; and III (eliminated December 31, 2003, to comply with HIPAA), local codes developed by regional Medicare Part B carriers an dused to report physician’s services and supplies to Medicare for reimbursment
healthcare effectiveness data and information set (HEDIS)
…a set of performance measures developed by the National Commission for Quality Assurance that are designed a provide purchasers and consumers of healthcare with the information they need to compare the performance of managed care plans.
healthcare provider
…a provider of diagnostic, medical, and suargical care as well as the services or supplies related to the health of anindividual an dany other peson or organization that issues reimbursement claims or is paid for healthcare in the normal course of business
home assessment validation and entry (HAVEN)
…a type of data entry software used to collect Outcome an dAssessment Informatin Set (OASIS) data and then transmit them to state databases; imports and exports data in standard OASIS record format, maintains agency/patient/comployee information, enforces data integrity through rigorous edit checks, and provides comprehensive online help
home health agency (HHA)
…a program or organization that proivdes a blend of homebased medical and social services to homebound patients and their families for teh purpose of promoting, maintaining, or restroing health or of minimizing the effects of illness, injury, or disability
home health prospecitive payment system HH PPS)
…the reimbursement system developed by the Centers for Medicare and Medicaid Services to cover home health services provided to Medicare beneficiaries
home health resource group (HHRG)
…a classification system with 80 hmoe health episode rates established to support the prospecitive reimbursement of covered home care and rehabilitation services provided to Medicare beneficiaries during 60 day episodes of care
hospice
…an interdisciplinary program of palliative care and supportive services that addresses the physical, spiritaul, social, and economic needs of terminally ill patients and their families
hospital acquired condtions (HAC)
…select, responably preventable conditions for which hospitals do not receive additional payment when one of the conditions was not present on admission
hospitalization insurance (HI) (Medicare Part A)
…a federal program that covers teh costs associated weith inpatient hospitalization as well as other healthcare services provided to Medicare beneficiaries
indemity plans
…health insurance coverage provided in the form of cash payments to patients or providers
independent practice association (IPA)
…an open panel health maintenance organization that provides contract healthcare services to subscribers through independent pysicians who treat patients in their own offices; the HMO reimburses the IPA on a capitated basis; the IPA may reimburse the physicians on a fee for service or a capitated basis
indian health service (IHS)
…the federal agnecy within the Department of Health and Human Services that is responsibel for providing federal healthcare services to
American Indians and Alaska natives
inpatient psychiatric facility (IPF)
…a healthcare facility that offers spychiatric medical care on an inpatient basis; CMS established a prospective payment system for reimbursing these types of facilities using the current DRGs for inpatient hospitals
inpatient rehabilitation facility (IRF)
…a healthcare facility that specializes in providing services to patients who have suffered a disabling illness or injury in an effort to help them achieve or maintain their optimal level of functioning, self care and independence
inpatient rehabilitation validation and entry (IRVEN)
…a computerized data entry system used by inpatient rehabilitation facilities
insured
…a holder of a health insurance policy
insurer
…an organiztion that pays healthcare expenses on behalf of its enrollees
integreated delivery system (IDS)
…a system that combines the financial and lcinicasl aspects of ehalthcare and uses a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care
Integrated provider organization (IPO)
…an organization that manages the delivery of healthcare services provided by hospitals, physicians, (employees of the IPO), and other healthcare organizations
long term care hospital (LTCH)
…a hospital with an average length of stay of 25 days or more
low utilization payment adjustment (LUPA)
…an alternative (reduced) payment made to home health agencies instead of teh home health resource group reimbursement rate when a patient recieves fewer than four home care visits during a 60 day episode
major diagnostic category (MDC)
…under diagnosis related groups (DRGs), one of 25 categories based on single or multiple organ sysetms into which all disease and disorders relating to that system are classifeid
Major medical insurance
…prepaid healthcare benefits that include a high limit for msot types of medical expenses and usually require a large deductible and sometimes place limits on coverage and charges
managed care
…paymnet method in which the third party payer has implemented some provisions to control the costs of heatlhcare while maintaining quality care 2. systematic merger of clinical, financial, and administrative processes to manage access, cost, and quaity of heatlhcare.
management service organization (MSO)
…an organiztion, ususally owned by a group of physicians or a hospital, that provides adminstrative and support services to one or more physician group practices or small hospitals
Medicaid
…an entitlement program that oversees medical assistance for individuals and families with low incomes and limited resources; jointly funded between state and federal governments
medical foundation
…multipurpose, nonprofit service organization for physicians and other healthcare providres at the local and county level; as managed care organizatoins, they have established preferred provider organizations, exclusive provider organizations, and management service organizations with emphases on freedom of choice and preservation of the physician patient relationship
medically needy option (Medicaid)
…an option in the Medicaid program that allows states to extend eligibility to persons who would be eligible for Medicaid under one of the mandatory or optional groups buyt whose income and/or resources fall above the eligibility level set by their state.
Medicare
…a federally funded health program estabished in 1965 to assist with the medical care costs of Americans 65 years and older as well as other individuals entitled to Social Security benefits owing to their disabilities
medicare administrative contractor (MAC)
…newly established contracting entities that will administer Medicare Part A and Part B as of 2011
medicare advantage
…optional managed care plan for Medicare beenficiaries who are entitled to Part and, enrolled in Part B, and live in an area with a plan/ types include health maintenance organization, point of service plan, preferred provider organization, and proivder sponsored organization.
medicare carrier
…a health plan that processes Part B claims for services by physicians and medical suppliers
medicare fee schedule (MFS)
…a feature of the resource-based relative value system that includes a complete list of the payments Medicare makes to physicians and other providers
medicare severity diagnosis-related groups (MS-DRGs)
…the US government’s 2007 revision of the DRG system, the MS-DRG system better accoutns for severity of illness and resource consumption
Medicare Summary Notice (MSN)
…a summary sent to the patient from Medicare that summarizes all services provided over a period of time with an explanation of benefits provided
Medigap
…a private insurance policy that supplements Medicare coverage
Minimum Data Set 3.0 (MDS)
…a federally mandated standard assessment form that Medicare and/or Medicaid certified nursing facilities must use to collect demographic and clincial data on nursing home residents.
National Committee for Quality Assurance (NCQA)
…a private, not for profit accreditation organization whose mission is to evaluate an dreport aon the quality of managed care organizations in the United States
National conversion factor (CF)
…a mathematical factor used to convert relative value units into monetary payments for services provided to Medicare beneficiaries
National correct coding initiative (NCCI)
…a series of codes edits on Medicare Part B claims
national uniform billing committee (NUBC)
…the national group responsible for identifying data elements and designing the CMS-1500
network model HMO
…program in which participating HMOs contract for services with one or more multispecialty group practices
network provider
…a physician or another healthcare professional who is a member of a managed care network
nonparticipating providers
…a healthcare provider who didi not sign a participation agreement with Medicare and so is not obligated to accept assignment on Medicare claims
omnibus budget reconciliation act (OBRA)
…federal legislation passed in 1987 that required the Health Care Financing Adminstration ( now named the Centers for Medicare and Medicaid Services) to develop an assessment instrument (called the resident assessment instrument) to standardize the collection of patient data from skilled nursing facilities
outcomes and assessment information set (OASIS)
…a standard core assessment data tool develped to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs
out of pocket expenses
…healthcare costs paid by the insured after which the insurer pays a percentage of covered expenses
outpatient code editor (OCE)
…a software program linked to the Correct Coding Initiative that applies a set of logical rules to determine whether various combinations of codes ar ecorrect and appropriately represent the servcies provided.
outpatient prospective payment system (OPPS)
…the Medicare prospective payment system used for hospital based outpatient services and procedures that is predicated onteh assignment of ambulatory payment classifications
packaging
…a payment under the Medicare outpatient prospective payment system that includes items such as anesthesia, supplies, certain drugs, and the use of recovery and observation rooms
partial hospitalization
…a term that refers to limited patients stays inteh hospital setting, typically as part foa transitional program to a less intense level of service
patient protection and affordable care act
…a federal statue that was signed into law on March 23, 2010. along with the Health Care and Education Reconciliation Act of 2010, the Act is the product of the healthcare reform agenda of the Demoncratic 111th Congress and Obama administration
payer of last resort (Medicaid)
…a Medicaid term that means that Medicare pays for the services provided to individuals enrolled in both Medicare and Medicaid until Medicare benefits are exhauseted and Medicaid benefits begin
payment status indicator (PSI)
…an alphabetic code assigned to CPT/HCPCS codes to indicate whether a service or procedure is to be reimbursed under the Medicare outpaiten prospective payment system
per member per month (PMPM)
…a type of manaed care arrangement by which providers are paid a fixed fee in exchange for supplying all of the healthcare services an enrollee needs for a specified period of time (usually one month but sometimes on year.
per patient per month (PPPM)
…a type of manaed care arrangement by which providers are paid a fixed fee in exchange for supplying all of the healthcare services an enrollee needs for a specified period of time (usually one month but sometimes on year.
physician hospital organization (PHO)
…an integreated delivery system formed by hospitals an dphysicians (usually through managed care contracts) that allows for cooperative activity but permits participants to retain some level of independence
point of service (POS) plan
…a type of managed care plan in which enrollees are encouraged to select healthcare providers forma network of providers under contract with the plan but are also allowed to select providers outside the network and pay a larger share of the cost
policyholder
…an individual or entity that purchases healthcare insurance coverage
precertification
…process of obtainign approval from a healthcare insurance company before receiving healthcare services
preferred provider organization (PPO)
…a managed care arraqngement bassed ona contractual agreement between healthcare providers (professional and/or istitutional) an dto a defined population of enrollees at established fees that may or may not be a discount from usual and customary or reasonab le charges
premium
…amount of money that a plicyholder or certificate holder must periodically pay an insurer in return for healthcare coverage
present on admission (POA)
…a condition preent at the time of inpatient admission
Primary care physician (PCP)
…the physiciabn who proivdes, supervises, and coordinates teh healthcare of a member and who manages referrals to other healthcare providers and utilization of healthcare services both inside and outside a managed care plan. 2. the physician who makes the initial diagnosis of a patient’s medical condition
principle diagnosis
…the disease or condition that wa present on admission, was the principal reason for admission, and received treatment or evalutaion during the hospital stay or visit.
principle procedure
…the procedure preformed for the definitive treatment of a condition (as opposed to a procedure performed for diagnostic or exploratory purposes) or for care of a complication
professional component (PC)
…the portion of a healthcare procedure performed by a physician 2. a term generally used in reference to the elements of radiological procedures performed by a physician
programs of all inclusive care for the elderly (PACE)
prospective payment system (PPS)
…a type of reimbursement system that is based on preset payment levels rather than actual charges billed after the service has been provided;
public assistance
…a monetary subsidy provided to financially needy individuals
relative value unit (RVU)
…a number asigned to a procedure that describes its difficulty and expense in relationship to other procedures
remittance advice (RA)
…an explanation of payments made by third party payers
resident assessment instrument (RAI)
…a uniform assessment instrument deveoped by the Centers for Medicare and Medicaid Services to standardize the collection of skilled nursing facility patient data
resident assessment validation and entry (RAVEN)
…a type of data entry software develpoed by the Centers for Medicare and Medicaid Services for long-term care facilities and used to collect Minimum Data Set assessments and to transmit data to state databases
resource utilitzation groups, version IV (RUG-IV)
…a case mix adjusted classification system based on Minimum Data Set assessments and used by skilled nursing facilities
resource based relative value sale (RBRVS)
…a Medicare reimbursement system implemented in 1992 to compensate physicians according to a fee schedule predicated on weights assigend on the basis of the resources required to provide the services
respite care
…a type or short term care provided during the day or overnight to idividuals in the home or institution to temporily relieve the family home caregiver
retrospective payment system
…type of fee for service reimbursement in which providers receive recompense after health services have been rendered
recovery audit contractor (RAC)
…organization contracted to detect and correct improper payments inthe Medicare Fee for Service (FFS) Program
revenue codes
…a three or four digit number in the chargemaster that totals all items and their charges for printing on the form used for Medicare billing
skilled nursing facility prospective payment sysetm (SNF PPS)
…a per diem reimbursement system implemented in July 1998 for costs (routine, ancillary, and capital) associated with covered skilled nursing facility services furnished to Medicare Part A beneficiaries
social security act
…the federal legislation that originally established the Social Security program as well as unemployment compensation, and support for mothers and children, amended in 1965 to createthe Medicare and Medicaid programs
staff model HMO
…a type of health maintenance that employs physicians to provide healthcare services to subscribers
state children’s health insurance program (SCHIP)
…the children’s healthcare prgram im[plemented as part of the Balanced Budget Act of 1997;
state workers’ compensation insurance funds
…funds that proivde a stable source of insurance coverage for work-realted illnesses and injuries and serve to protect employers from underwriting uncertainties by making it possibel to have continuing availability of workers’ compensation coverage
supplemental medical insurance (SMI) (Medicare Part B)
…a voluntary medical insurance program that helps pay for physicians’ services, medical services, an dsupplies not covered by Medicare Part A
tax equity and fiscal responsibility act of 1982 (TEFRA)
…the federal legislation that modified Medicare’s retrospective reimbursement system for inpatient hospital stays by requiring implementation of diagnosis related groups and the acute care prospective paymenbt systm
technical component (TC)
…the portion of radiological and othe rprocedures that is facility based or nonphysician based
temporary assistance for Needy families (TANF)
…a federal program that provides states with grants to be spent on time limited cash assistance for low income families, generally limiting a family’s lifetime cash welfare benefits to a maximum of five years and permitting states to impose other requirements.
third party payer
…an insurance company that reimburses healthcare providers and/or patients for the delivery of medical services
traditional fee for service reimbursement
…a reimbursement method involving third party payers who compenstae providers after the healthcare services have been delivered; payment is based on specific services provided to subscribers
tricare
…the federal healthcar program that provides coverage for the dependents fo armed forces personnel and for retirees receivign care outside military treatment facilities in which the federal government pays a percentage of the cost formerly known as teh Civilian Health and Medical Program of the Uniformed SErvices
tricare extra
…a cost effective preferred provider network TRICARE option in which costs for healthcare are lower than fo the standard TRICARE program because a physician or medical specialist is selected from a network of civilian healthcare professionals whoparticipate in TRICARE Extra
tricare prime
…a TRICARE progarm that provide the most comprehensive healthcare benefits at the lwoest cost of the three TRICARE options, in which military treatment facilities erve as the principal source of healthcare and aprimary care manager is assigned to each enrollee
tricare standard
…a TRICARE program that allows elegible beneficiaries to choose any physician or healthcare provider, which permits the most flexiblity but may be the most expensive
UB-04 (CMS-1450)
…the single standardized Medicare form for standardized uniform billing, scheduled for implementation in 2007 for hospital inpatients and outpatients; this form will also be used by the major third party payers and most hospitals
unbundling
…the practice of using multiple codes to bill for the various individual steps in a singel procedure rather than using a single code that includes all of the steps of the comprehensive procedure
upcoding
usual, customary, and reasonable (UCR) charges
method of evaluating providers’ fees in which the third party payer pays for fees that are usual in that providers’ practice
veterans health administration
…the component of the U.S.Department of Veterans Affiars that implements the medical assistance program of the VA
voluntary disclosure program
…a progarm unveiled in 1998 by the Office of the Inspector General (OIG) that encourages healthcar providers to voluntarily report fraudulent conduct affecting Medicare, Medicaid, and other federal healthcare programs
workers’ compensation
…the medical and income insurance coverage for certain employees in unusually hazardous jobs.