Bill for services rendered to a patient receiving benefits simultaneously from Medicare and Medicaid or from Medicare and a Medigap supplemental plan. Medicare pays first and then determines the amounts of unmet Medicare deductible and coinsurance to be paid by the secondary insurance carrier. The claim is automatically transferred (electronically) to the secondary insurance carrier for additional payment; also known as claims transfer.

Beneficiary who has both Medicare and Medicaid coverage. Sometimes referred to as a Medi-Medi or Care/Caid case.

1. Cross-reference of CPT codes with ICD-9-CM, anesthesia, dental, or HCPCS Level II codes. Also known as data mapping. 2. Cross-reference connection between discontinued CPT codes and new codes that replace them. Also called visit crosswalk. 3. Mapping to locate the corresponding diagnosis between an ICD-9-CM code set and an ICD-10-CM code set.

When a new test is determined to be similar to an existing test, multiple existing test codes, or a portion of an existing test code, the new test code is then assigned the related existing local fee schedule amounts and resulting national limitation amount. In some instances, a test may only equate to a portion of a test and, in those instances, payment at an appropriate percentage of the payment for the existing test is assigned.

Another method for establishing a conversion factor under the Volume Performance Standard system. It brings actual spending in line with targeting spending and also recovers any surpluses or shortfalls in spending from 2 years before Medicare updates in the fee schedule are made.

In workers’ compensation cases, that occurring as repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability the need for medical treatment.