Procedure in which an injection of a nontoxic radiopaque medium is given in order to produce movie camera images on a fluorescent screen to view various body structures.

Symbol used in the procedure code book titled Current Procedural Terminology (CPT) to indicate that conscious/moderate sedation is included for that specific procedural code number for billing and payment purposes.

Fines and sanctions imposed on individuals or health care facilities by the Office of Inspector General (OIG) for noncompliance with Centers for Medicare and Medicaid Services (CMS) regulations. This includes fraud violations. These fines may be in addition to other criminal and civil penalties depending on the legal situation.

Program for federal employees hired before 1984.

Service benefit program similar to TRICARE, which is for veterans with total, permanent, service-connected disabilities or surviving spouses and dependents of veterans who died from service-connected disabilities. The Veterans Administration is now known as the Department of Veterans Affairs.

National administrative code set that identifies the reasons for any differences, or adjustments, between the original provider charge for a claim or service and the payer’s payment for it. This code set is used in the X12 835 claim payment and remittance advice and the X12 837 claim transactions and is maintained by the Health Care Code Maintenance Committee.

Section or division in a life and health insurance company that processes insurance claims. In this division, claim examiners review claims submitted by medical providers, policy owners, or beneficiaries; verify the validity of claims; and authorize payment of benefits to either the provider or beneficiary of each claim.

Document with information, hard copy or electronic, related to a completed insurance claim that assists in validating the medical necessity or explains the medical service or procedure (e.g., operative report, discharge summary, invoice). When a claim attachment is included with a paper claim, Block 19 of the CMA-1500 insurance claim form is completed. When a claim is electronically transmitted, practice management and claims software include a data field that indicates that a paper claims attachment is included with the claim. Under the Health Insurance Portability and Accountability Act (HIPAA), electronic standards for claims attachments are being developed. Attachments may be structured (such as Certificates of Medical Necessity) or nonstructured (such as an operative report). Though attachments may be submitted separately, it is common to say the attachment was “submitted with the claim.”