In the Correct Coding Initiative (CCI) edits, the code that follows the column I code, which cannot be billed when the more comprehensive code is billed.

Standardizing method that allows a physician to list a code, regardless of specialty, that specifically identifies whether the procedural component, the radiological component, or both aspects of the service was provided.

1. Flat or standard rate charged to all enrollees of a managed care plan in a particular group regardless of whether they are enrolled for single or family coverage. 2. Phrase that describes the average unit cost per employee covered. 3. In the Medicare program, this system is one of two methods of payment for dialysis services rendered in the patient’s home. Payment does not include the physician’s professional services, separately billable laboratory services, and separately billable drugs.
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A special single rate based upon a measure of exposure which reasonably reflects the variations in the insurable hazards covered for a particular insured. Bases of exposure to which the composite rate is applied include but are not limited to pay roll, sales, receipts and contract cost.

MEDICAL,USA: 1. Term used to describe a level of history and/or physical examination. 2. When an audit is taking place, term that indicates a general multisystem examination (eight or more organ systems or complete examination of a single organ system).
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A loosely used term signifying broad or extensive coverage of insurance.
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UK: A term describing a policy with a number of different types of cover in one document (e.g. a private car comprehensive policy has sections providing material damage cover, third party cover, personal accident cover, medical expenses, etc.).

Federal legislation in 1970 that protects the confidentiality of the identity, diagnosis, prognosis, or treatment of any patient for alcohol abuse.

1. Single procedural code that describes or covers two or more CPT component codes that are bundled together as one unit.2. Under the Correct Coding Initiative (CCI), a file known as component edits lists pairs of codes considered an integral part of the main surgical service provided. The comprehensive procedure is listed first and then behind it is a component code.

In the Correct Coding Initiative (CCI) edits, a column I comprehensive code that represents the major procedure or service when billed with another code.

Insurance agreement that protects and covers all named hazards or perils within the general scope of one contract except those specifically excluded.

One of two programs established by the Centers for Medicare and Medicaid Services (CMS) to monitor and report the accuracy of Medicare FFS payments: the Comprehensive Error Rate Testing (CERT) program and the Hospital Payment Monitoring Program (HPMP). The national error rate is calculated using a combination of data from the CERT contractor and HPMP with each component representing about 60% and 40% of the total Medicare FFS dollars paid. The CERT program measures the error rate for claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (FIs). The HPMP measures the error rate for the quality improvement organizations (QIOs). Beginning in 2003, CMS elected to calculate a provider compliance error rate in addition to the paid claims error rate. The provider compliance error rate measures how well providers prepare Medicare FFS claims for submission. CMS calculates the Medicare Fee-For-Service error rate and estimate of improper claim payments using a methodology the OIG approved. The CERT methodology includes randomly selecting a sample of approximately 120,000 submitted claims, requesting medical records from providers who submitted the claims, and reviewing the claims and medical records for compliance with Medicare coverage, coding, and billing rules.

In 1995 the American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) developed documentation guidelines for CPT evaluation and management services and modified them in 1997.Comprehensive examination 1995 guidelines: a general multisystem examination or a complete examination of a single organ system. Comprehensive examination 1997 guidelines for multisystem examination: at least nine organ systems or body areas. For each system or area selected, all elements of the examination identified in a table by a bullet (•) should be performed, unless specific directions limit the content of the examination. For each area or system, documentation of at least two elements identified in a table by a bullet (•) is expected. The 1997 guidelines for a single organ system examination: performance of all elements identified in a table by a bullet (•), whether in a shaded or unshaded box. Documentation of every element in each shaded box and at least one element in each unshaded box is expected. Review/Audit worksheet of a general multiorgan system physical examination that shows the details (elements) of examination for each body area/system.