1. Significant number of daily evaluation and management (E&M) visits by the same physician to multiple patients at a facility within a 24-hour period. When insurance claims reach the insurance carrier in this type of situation, it may result in medical review to determine medical necessity for the visits. 2. In Medicare fraud, to bill based on gang visits (e.g., a provider who visits a nursing facility and bills for 20 visits without furnishing any specific service to, or on behalf of, individual patients).

CPT codes that are not covered by the Medicare program; thus they do not have relative values under the resource-based relative value scale (RBRVS).

Term used when no comparable, existing test is available. Insurance carrier specific amounts are used to establish a national limitation amount for the following year.

In the Medicare program, costs or services that are not covered under the Medicare plan; referred to as Medicare gaps .

1. Debtor against whom a plaintiff has begun a process of garnishment. 2. Individual who has had his or her salary attached as payment toward a debt.

Court order attaching a debtor’s property or wages to pay off a debt to the plaintiff.
****
Legal notion to appear in court. Also a legal warning to persons or companies holding another’s property that it is thus attached and should not be delivered to the owner but should be accounted for in a court. In some cases money or settlement under an Insurance Policy is subject to garnishment.

Study and treatment of diseases affecting the gastrointestinal (GI) tract including the esophagus, stomach, intestines, gallbladder, and bile duct. It is a subspecialty of internal medicine.

In a managed care system, the primary care physician who is the first doctor the patient seeks for nonemergency care and determines whether referral to a specialist is medically appropriate. The gatekeeper also controls patient access to diagnostic testing services. In some managed care plans, a nurse practitioner or physician assistant is appointed to this role. Also called primary care physician and referral provider .

Process in which a managed care system’s gatekeeper provides the initial patient care, schedules diagnostic testing services, and refers patients to specialists when necessary.