mod5 admin terms

29 terms by imbc2u 

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accounting cycle

the flow of financial transactions in a business

accounts receivable

money coming into the business

adjudication

series of steps that determine whether a claim should be made

billing cycle

regular schedule of sending statements to patients

capitation

advance pymts to a provider that covers each plan member's health care services for a certain period of time

coding

the process of assigning standardized codes to diagnoses and procedures

coinsurance

the part of charges that an insured person must pay for health care services after pymt of deductible

consumer-driven health plan-CDHP

a type of managed care in which a high deductible/low premium insurance plan in combined with a pretax savings account to cover out-of -pocket expenses

copayment

a small fixed fee paid by the patient at the time of an office visit

diagnosis code

a standardized value that represents a patient's illness, signs and symptoms

encounter form

a list of procedures and charges for a patient's visit

explanation of benefits EOB

paper document from insurance company that shows how the amount of a benefit was determined

fee-for-service

health plan that repays the policyholder for covered medical expenses-common in traditional plans

health maintenance organization-HMO

a managed health care system in which providers agree to health care for the HMO's members for fixed payments from the plan

health plan

a plan, program or organization that provides health care benefits

managed care

a type of health coverage where the carrier is responsible for both the financing and delivery of health care

medical coder

a person who analyzes and codes patient diagnoses, procedures and symptoms

medical necessity

treatment provided by a physician to a patient for the purpose of preventing, diagnosing or treating an illness, injury or its symptoms in a manner that is approriate to generally accepted standards

patient information form

a form that includes a patient's personal, employment and insurance data needed to complete the insurance claim

payer

private or government organization that insures or pays for health care on the behalf of the beneficiaries

policyholder

any person who buys an insurance plan; the insured

practice management program-PMP

a software program that automates many of the administrative and financial tasks required to run a medical practice

preferred provider organization-PPO

a managed health care system where a network of providers agree to perform services to plan members at a discounted fee

premium

the amount the insured pays for insurance coverage

procedure

medical treatment provided by a physician or other health care provider

procedure code

a code that identifies a medical service

remittance advice-RA

an explanation of benefits (EOB) transmitted electronically

statement

a list of all services performed for a patient, along with the charges for each service

diagnosis

physician's opinion of the nature of the patient's illness or injury

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