CPT Modifers
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Additional codes that indicate that a service was altered in some way from
the stated CPT description without actually changing the basic definition of
the service. Modifiers can indicate: a service or procedure that has both a
professional and a technical component; a service or procedure that was
preformed by more than one physician; that only part of a service was
performed; that an adjunctive service was performed; that a bilateral
procedure was preformed; that service or procedure was provided more
than once; an unusual event occurred, or a procedure or service was
, altered in some way. A compete listing of all modifiers used in CPT coding
is located in an appendix of CPT
Somatiform disorders
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there is no medical explanation for symptoms and psychological
explanations should be explored.
FIM (Functional Independence Measure)
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is the most widely accepted functional assessment measure in use in the
rehabilitation community. The FIM(TM) is an 18-item ordinal scale, used with
all diagnoses within a rehabilitation population. It is viewed as most useful
for assessment of progress during inpatient rehabilitation.
SS Ticket to Work program eligible
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Social Security's Ticket to Work Program is a free and voluntary program
available to people ages 18 through 64 who are blind or have a disability
and who receive Social Security Disability Insurance (SSDI) or
Supplemental Security Income (SSI) benefits.
,Benefit of Ticket to Work program
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beneficiaries can get the help they need to safely explore their work
options without immediately losing their benefits and find the job that is
right for them. Beneficiaries also can use a combination of work incentives
to maximize their income until they begin to earn enough to support
themselves.
Par Provider
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Shorthand for a provider who is participating in a health care plan.
Exceptions to MHPAEA 2008
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Except as noted below, MHPAEA requirements do not apply to:
Non-Federal governmental plans that have 100 or fewer employees; Small
private employers that have 50 or fewer employees; Group health plans
and health insurance issuers that are exempt from MHPAEA based on their
increased cost (except as noted below). Plans and issuers that make
changes to comply with MHPAEA and incur an increased cost of at least 2%
in the first year that MHPAEA applies to the plan or coverage or at least
one percent in any subsequent plan year may claim an exemption from
MHPAEA based on their increased cost. If such a cost is incurred, the plan
or coverage is exempt from MHPAEA requirements for the plan or policy
year following the year the cost was incurred. These exemptions last one
, year. After that, the plan or coverage is required to comply again; however,
if the plan or coverage incurs an increased cost of at least 1% in that plan or
policy year, the plan or coverage could claim the exemption for the
following plan or policy year; Large, self-funded non-Federal
governmental employers that opt-out of the requirements of MHPAEA.
Viatical Settlements
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the sale of a policy owner's existing life insurance policy to a third party for
more than its cash surrender value, but less than its net death benefit. Such
a sale provides the policy owner with an lump sum. The third party
becomes the new owner of the policy, pays the monthly premiums, and
receives the full benefit of the policy when the insured dies
-a settlement involving an insured who is terminally or chronically ill
Staff Model
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Employs providers directly and directs care through clinics, where
everything is in one place
( centralized). Physicians are more like employees for the HMO in this
setting rather than employees of a group or private practice.
Coinsurance
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Additional codes that indicate that a service was altered in some way from
the stated CPT description without actually changing the basic definition of
the service. Modifiers can indicate: a service or procedure that has both a
professional and a technical component; a service or procedure that was
preformed by more than one physician; that only part of a service was
performed; that an adjunctive service was performed; that a bilateral
procedure was preformed; that service or procedure was provided more
than once; an unusual event occurred, or a procedure or service was
, altered in some way. A compete listing of all modifiers used in CPT coding
is located in an appendix of CPT
Somatiform disorders
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there is no medical explanation for symptoms and psychological
explanations should be explored.
FIM (Functional Independence Measure)
Give this one a try later!
is the most widely accepted functional assessment measure in use in the
rehabilitation community. The FIM(TM) is an 18-item ordinal scale, used with
all diagnoses within a rehabilitation population. It is viewed as most useful
for assessment of progress during inpatient rehabilitation.
SS Ticket to Work program eligible
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Social Security's Ticket to Work Program is a free and voluntary program
available to people ages 18 through 64 who are blind or have a disability
and who receive Social Security Disability Insurance (SSDI) or
Supplemental Security Income (SSI) benefits.
,Benefit of Ticket to Work program
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beneficiaries can get the help they need to safely explore their work
options without immediately losing their benefits and find the job that is
right for them. Beneficiaries also can use a combination of work incentives
to maximize their income until they begin to earn enough to support
themselves.
Par Provider
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Shorthand for a provider who is participating in a health care plan.
Exceptions to MHPAEA 2008
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Except as noted below, MHPAEA requirements do not apply to:
Non-Federal governmental plans that have 100 or fewer employees; Small
private employers that have 50 or fewer employees; Group health plans
and health insurance issuers that are exempt from MHPAEA based on their
increased cost (except as noted below). Plans and issuers that make
changes to comply with MHPAEA and incur an increased cost of at least 2%
in the first year that MHPAEA applies to the plan or coverage or at least
one percent in any subsequent plan year may claim an exemption from
MHPAEA based on their increased cost. If such a cost is incurred, the plan
or coverage is exempt from MHPAEA requirements for the plan or policy
year following the year the cost was incurred. These exemptions last one
, year. After that, the plan or coverage is required to comply again; however,
if the plan or coverage incurs an increased cost of at least 1% in that plan or
policy year, the plan or coverage could claim the exemption for the
following plan or policy year; Large, self-funded non-Federal
governmental employers that opt-out of the requirements of MHPAEA.
Viatical Settlements
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the sale of a policy owner's existing life insurance policy to a third party for
more than its cash surrender value, but less than its net death benefit. Such
a sale provides the policy owner with an lump sum. The third party
becomes the new owner of the policy, pays the monthly premiums, and
receives the full benefit of the policy when the insured dies
-a settlement involving an insured who is terminally or chronically ill
Staff Model
Give this one a try later!
Employs providers directly and directs care through clinics, where
everything is in one place
( centralized). Physicians are more like employees for the HMO in this
setting rather than employees of a group or private practice.
Coinsurance
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