mod5 admin terms
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29 terms
Terms | Definitions |
|---|---|
 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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