Initiative of the National Recovery Project via the Office of the Inspector General that established guidelines for payments for resident doctors that are employed at teaching facilities treating Medicare patients. Such services are performed under Medicare Part B but are paid for as part of Medicare Part A.

A reference procedural code book using a numerical system and description for procedures for reporting and billing medical services and procedures. It is established and owned by the American Medical Association.

Annual publication that lists prescription drugs and diagnostic products and is used by physicians as a reference tool.

Compilation of each physician’s charges for specific professional services and the payments made to the physician over a given period of time.

Overall health condition of a patient as seen by the physician after a complete physical examination. Also see physician’s fee profile.

In the Medicare program, medical care provided by an individual who has state licensure to practice medicine or osteopathy.

To use a brief list of diagnostic codes and use those codes for all patients whether or not the codes match their actual diagnoses.

Abbreviation for provider identification number (PIN). PINs are now referred to as provider transaction access numbers (PTANs). See provider transaction access number (PTAN).

Excessive referrals to other providers for unnecessary services. A physician or facility may use this technique to gain favor with colleagues.