MEDISOFT MEDICAL TERMS
About this set
Created by:
lynettedegolyer on March 22, 2012
Subjects:
Log in to favorite or report as inappropriate.
Order by
120 terms
Terms | Definitions |
|---|---|
 ACCESS RIGHTS | , permissions assigned to a file or device, |
| ACCOUNTING CYCLE | flow of financial transactions |
| ACCOUNTS RECEIVABLE (AR) | Monies that are flowing into a business |
| ADJUDICATION | series of steps that determine whether a claim should be paid |
| ADJUSTMENTS | changes recorded on a work sheet to update general ledger |
| ADMINISTRATIVE SAFEGUARDS | administrative policies and procedures designed to protect electronic health information outlined by the HIPAA Security Rule |
| AGING REPORT | A report that lists the amount of money owed to the practice, organized by the amount of time the money has been owed |
| AUDIT/EDIT REPORT | a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer |
| AUDIT TRAIL | a report that traces who has accessed electronic information, and whether any information was changed |
| AUTO LOG OFF | feature of Medisoft that automatically logs a user out of the program after a period of inactivity |
| AUTO POSTING | computers programmed to enter information form an RA into patient's accounts are using |
| BACKUP DATA | a copy of data files made at a specific point in time that can be used to restore data to the system |
| BILLING CYCLE | regular schedule of sending statements to patients |
| BREACH | a failure to perform some promised act or obligation |
| CAPITATION | a tax levied on the basis of a fixed amount per person |
| CAPITATION PAYMENTS | PAYMENTS MADE TO PHYSICIANS ON A REGULAR BASIS FOR PROVIDING SERVICES TO PATIENTS IN A MANAGED CARE PLAN |
| CASE | A grouping of transactions for visits to a physicians office organized around a condition |
| CHARGES | Amounts a provider bills for the services performed |
| CHART | a folder that contains all records pertaining to a patient |
| CHART NUMBERS | first 5 last name, 1st 2 last name, sero |
| CLEAN CLAIMS | claims with all the correct information necessary for payer processing |
| CLEARINGHOUSE | a service company that recieves electronic or paper claims from the provider, checks and prepares them for processing, and transmits them in HIPAA-complaint format to the correct carriers |
| CODING | the process of assigning standardized codes to diagnoses and procedures |
| COINSURANCE | Part of charges that an insured person must pay for health care services after payment of the deductible amount |
| CMS-1500 (08/05) | the mandated paper insurance claim form |
| COLLECTION AGENCY | an outside firm hired to collect on delinquent accounts |
| COLLECTION LIST | a tool for tracking activities that need to be completed as part of the collection process |
| COLLECTION TRACER REPORT | a tool for keeping track of collection letters that were sent |
| COMPUTER-ASSISTED CODING | assigning preliminary diagnosis and procedure codes using computer software |
| CONSUMER-DRIVEN HEALTH PLAN (CDHP) | a type of managed care in which a high-deductible/low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit. |
| COPAYMENT | a small fixed fee paid by the patient at the time of an office visit |
| CYCLE BILLING | a type of billing in which patients are divided into groups and statement printing and mailing is staggered throughout the month |
| DATABASE | a collection of organized data that allows access, retrieval, and use of data |
| DAY SHEET | a report that provides information on practice activities for a twenty-four-hour period |
| DEDUCTIBLE | amount due before benefits start |
| DIAGNOSIS | Process of determining whether a presenting problem meets the established criteria for a specific psychological disorder. |
| DIAGNOSIS CODE | a standardized value that represents a patient's illness, signs, and symptoms |
| DOCUMENTATION | a record of health care encounters between the physician and the patient, created by the provider |
| ELECTRONIC DATA INTERCHANGE (EDI) | the exchange of routine business transactions from one computer to another using publicly available communications protocols |
| ELECTRONIC FUNDS TRANSFER (EFT) | electronic routing of funds between banks |
| ELECTRONIC HEALTH RECORD (EHR) | EHR, A patient record that is created using a computer with software. A template is brought up and by answering a series of questions data are entered. |
| ELECTRONIC MEDICAL RECORDS (EMRS) | the computerized records of one physician's encounters with a patient over time |
| ELECTRONIC PRESCRIBING | the use of computers and handheld devices to write and transmit prescriptions to a pharmacy in a secure digital format |
| ELECTRONIC REMITTANCE ADVICE (ERA) | A document electronically transmitted to the hospital to provide an explanation of payment determination for a claim. |
| ENCOUNTER FORM | a list of the procedures and charges for a patient's visit |
| ESTABLISHED PATIENT | a patient who has been seen by a provider in the practice in the same specialty within three years |
| EVIDENCE-BASED MEDICINE | medical care based on the latest and most accurate clinical research |
| EXPLANATION OF BENEFITS (EOB) | paper document from a payer that shows how the amount of a benefit was determined. |
| FEE-FOR-SERVICE | Health plan that repays the policyholder for covered medical expenses |
| FEE SCHEDULE | a list of charges for services performed |
| FILTER | a condition that data must meet to be included in a selection |
| GUARANTOR | An individual who promises to pay the medical bill by signing a form agreeing to pay or who accepts treatment constitutes an expressed promise. |
| HEALTH INFORMATION TECHNOLOGY (HIT) | technology that is used to record, store, and manage patient health care information |
| HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996) | Federal act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information. |
| HIPAA ELECTRONIC TRANSACTION CODE SET STANDARDS | regulations requiring electronic transactions such as claim transmission to use standardized formats |
| HIPAA PRIVACY RULE | regulations for protecting individually identifiable information about a patient's past, present, or future physical and mental health and payment for health care that is created or received by a health care provider |
| HIPAA SECURITY RULE | regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information |
| INSURANCE AGING REPORT | a report that lists how long a payer has taken to respond to insurance claims |
| KNOWLEDGE BASE | a collection of up-to-date technical information |
| MANAGED CARE | a type of insurance in which the carrier is responsible for both the financing and the 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 appropriate and provided in accordance with generally accepted standards of medical practice |
| MEDICAL RECORD | a chronological record of a patient's medical history and care that includes information that the patient provides, as well as the physician's assessment, diagnosis, and treatment plan |
| MEDISOFT PROGRAM DATE | DATE THE PROGRAM USES TO RECORD WHEN A TRANSACTION OCCURED |
| MMDDCCYY FORMAT | the way dates must be keyed in Medisoft, in which MM stands for the month,DD stands for day,CC represents the century, an YY stands for year |
| MODIFIER | a two-digit character that is appended to a CPT code to report special circumstances involved with a procedure or service |
| MULTILINK CODES | groups of procedure code entries that relate to a single activity |
| NATIONAL PROVIDER IDENTIFIER (NPI) | a standard identifier for all health care providers consisting of ten numbers |
| NAVIGATOR BUTTONS | buttons that simplify the task of moving from one entry to another |
| NEW PATIENT | A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years. |
| NSF CHECK | a check that is not paid by a bank because of insufficient funds in a bank account |
| OFFICE HOURS BREAK | a block of time when a physician is unavailable for appointments with patients |
| OFFICE HOURS CALENDAR | an interactive calendar that is used to select or change dates in office hours |
| OFFICE HOURS PATIENT INFORMATION | the area of the Office Hours window that displays information about the patient who is selected in the provider's daily schedule |
| ONCE-A-MONTH BILLING | a type of billing in which statements are mailed to all patients at the same time each month |
| PACKING DATA | the deletion of vacant slots from the database |
| PATIENT AGING REPORT | A report that lists a patients balance by age, date and amount of the last payment, and telephone number |
| PATIENT DAY SHEET | a summary of patient activity on a given day |
| PATIENT INFORMATION FORM | form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim. |
| PATIENT LEDGER | a record of all charges and payments made on a particular patient's account |
| PATIENT STATEMENT | a list of the amount of money a patient owes, organized by the amount of time the money has been owed, the procedures performed, and the dates the procedures were performed |
| PAYER | a person who pays money for something |
| PAYMENT DAY SHEET | a report that lists all payments received on a particular day, organized by provider |
| PAYMENT PLAN | an agreement between a patient and a practice in which the patient agrees to make regular monthly payments over a specified period of time |
| PAYMENT SCHEDULE | A DOCUMENT THAT SPECIFIES THE AMOUNT THE PAYER AGREES TO REIMBURSE THE PROVIDER FOR A SERVICE |
| PAYMENTS | monies received from patients and insurance carriers |
| PERSONAL HEALTH RECORDS PHRS) | documentation of a person's health, health care, and health care providers. |
| PHYSICAL SAFEGUARDS | mechanisms required to protect electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion |
| POLICY HOLDER | a person who buys an insurance plan; the insured |
| PRACTICE ANALYSIS REPORT | a report that analyzes the revenue of a practice for a specified period of time, usually a month or a year |
| 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) | Managed care network of health care providers who agree to perform services for plan members at discounted fees |
| PREMIUM | payment or reward (especially from a government) for acts such as catching criminals or killing predatory animals or enlisting in the military |
| PRIMARY INSURANCE CARRIER | the first carrier to whom claims are submitted |
| PROCEDURE | a process or series of acts especially of a practical or mechanical nature involved in a particular form of work |
| PROCEDURE CODE | A code that identifies a medical service |
| PROCEDURE DAY SHEET | a report that lists all the procedures performed on a particular day, in numerical order |
| PROMPT PAYMENT LAWS | state laws that mandate a time period within which clean claims must be paid; if they are not, financial penalties are levied against the payer |
| PROTECTED HEALTH INFORMATION (PHI) | information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person |
| PROVIDER SELECTION BOX | a selection box that determines which providers schedule is displayed in the providers daily schedule |
| PROVIDER'S DAILY SCHEDULE | a listing of time slots for a particular day for a specific provider that corresponds to the date selected in the calendar |
| PURGING DATA | the process of deleting files of patients who are no longer seen by a provider in a practice |
| REBUILDING INDEXES | a process that checks and verifies data and corrects any internal problems with the data |
| RECALCULATING BALANCES | the process of updating balances to reflect the most recent changes made to the data |
| RECORD OF TREATMENT AND PROGRESS | A record that contains the physicians notes about a patient's condition and diagnosis. |
| REFERRING PROVIDER | a physician who recommends that a patient see a specific other physician |
| REMAINDER STATEMENTS | statements that list only those charges that are not paid in full after all insurance carrier payments have been received |
| REMITTANCE ADVICE (RA) | an explanation of benefits transmitted electronically by a payer to a provider |
| RESTORING DATA | the process of retrieving data from backup storage devices |
| SELECTION BOXES | fields within the search dialog box that are used to select the data that will be included in a report |
| SPONSOR | someone who supports or champions something |
| STANDARD STATEMENTS | statements that show all charges regardless of whether the insurance has paid on the transactions |
| STATEMENT | a document showing credits and debits |
| TECHNICAL SAFEGUARDS | automated processes used to protect data and control access to data |
| TICKLER | a file of memoranda or notices that remind of things to be done |
| UNCOLLECTABLE ACCOUNT | an account that does not resopond to collect efforts and is written off the practice's expected accounts receivable |
| WALKOUT STATEMENT | a document listing charges and payments that is given to a patient after an office visit |
| WORKFLOW | progress (or rate of progress) in work being done |
| WRITE-OFF | To discount a patient's fee in accordance with contractual agreements |
| X12-837 HEALTH CARE CLAIM (837P) | HIPAA standard format for electronic transmission of a professional claim from a provider to a health plan. |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.