Medical Office II Week 3 Medical Terms

Created by mrc13b2006 

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Medical Office II Week 3 Medical Terms

trache/o

trachea (windpipe)

cost/o

rib

glyc/o

sugar, glucose

nat/i

birth

cardi/o

heart

cyt/o

cell

ren/o

kidney

top/o

place, position

furc/o

forking, branching

ante-

before

anti-, contra-

against

ec-

out, side

brady-

slow

infra-

inferior to

inter-

between

hypo-

deficient

sym-, syn-

with, together

hyper-

excessive

peri-

surrounding

re-

back, again

per-

through

meta-

change

cata-

down

post-

after

supra-

above

ad-

toward

dys-

painful, bad

epi-

above, upon

eu-

normal

intra-

into

de-

lack of

para-

near

tachy-

fast

ab-

away from

pro-

before

hemi-

half

pseudo-

false

micro-

small

-plasia

developement, formation

-al, -eal, -ic, -tic

pertaining to

-emia

blood condition

-penia

deficiency

-partum

birth, labor

-lapse

fall, sag

-rrhea

flow, discharge

-pnea

breathing

-trophy

nourishment, development

-mortem

death

-stasis

stopping, control

-drome

to run

-ion

process

-sis

state of condition

infracostal

pertaining to below the ribs

endotracheal

pertaining to within the trachea

dysplasia

condition of abnormal formation

ectopic

pregnancy that is out of place

bifurcation

correct spelling for the process of branching in two

benign

correct spelling for harmless, not cancerous

pancytopenia

deficiency in all (blood) cells

intercostal

pertaining to between the ribs

syndrome

correct spelling for symptoms that occur together

symbiosis

correct spelling for living together for mutual benefit

metastasis

correct spelling for beyond control (spread)

bradycardia

slow heart rate

diarrhea

correct spelling for complete flow of the colon

postnatal

pertaining to after birth

postmortem

correct spelling for after death

antibiotic

correct spelling for substance against germ life

hypoglycemia

blood condition of less than normal sugar

neonatal

correct spelling for new born

antibody

correct spelling for protein made by leukocyte to fight infection

assignment of benefits

The authorized signature of the patient for payment to be paid directly to the physician for services

deductible

a pre-determined amount that the insured must pay each year before the insurance company will pay for an accident or illness

managed care

a system of medial team members and groups who provide quality and cost effective care that encompasses both healthcare delivery and payment for services

$5-$20

Normal amount range for HMO co-payment (from book)

injectables

HCPCS Level II 'J' codes depict these

champus, tricare

established to aid dependents of active service personnel, retired service personnel and their dependents, and dependents of service personnel who died on active duty wth a supplement for medical care in military of Public Health Service facilities

effective date

the date when the insurance policy goes into effect

medicaid

a joint funding program by federal and state governments (excluding AZ) for low income patients on public assistance for their medical care

group model

Type of HMO where physicians are reimbursed on a capitated basis

CPT

To determine a code, the name of the procedure or service that most accurately identifies the service performed is selected. You are looking in this book?

champva

Established for the spouses and dependent children of veterens who have total, permanent, service connected disabilities

gatekeeper

a primary care physician who coordinates the patient's hosptial admissions, care received from specialists and so on

precertification

Prior authorization for hosptial admission and some outpatient and in-office procedures

staff model

type of HMO where you would find different specialties all in the same location

correctly and completely

A coding rule: code ____ and ____ any diagnosis or procedure that affects the care, influences the health status, or is a reason for treatment on that visit

coordination of benefits COB

Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy

group insurance

insurance offered to all employees by the employer

pre-existing condition

a condition that existed before the insured's policy was issued

independent practice association IPAs

Type of HMO that is composed of individual health care providers joined together to provide prepaid healthcare to groups and individuals

insurance card

You always need a copy of this to complete the insurance claim form

copayment or co-insurance

a specified amount that the insured must pay toward the charge for professional services rendered

health maintenance organization HMO

a prepaid group practice serving a specific geographic area with a wide range of comprehensive health care at a fixed fee schedule

service area

the geographic area served by an HMO

does not meet NCQA standards

a reason why accreditation would be denied to an HMO

consent to release of information to the ins company

You must have patient's signature before processing a claim...why?

subscriber

the person who is insured; an insurance policy holder

individual and group

Two types of insurance

80%

Reimbursement rate for medical (percentage)

follow up by calling the insurance company

If you have filed a claim and have not received payemnt or a denial, you should do this

gatekeeper

in a managed care delivery system, this person is responsible for coordinating all care for the patient

superbill

a printed form containing a list of the services with corresponding codes (encounter form)

premium

any individual may buy individual health insurance by paying this required payment?

$100

The deductible amount for Medicare

wrong pt ID number, claim suspended additional info, wrong ICD9 code

Some reasons for delays in payment

80/20

traditional indemnity insurance coverage is often referred to as this type of plan (ratio)

usual charge

the charge physicians make to their private patients

patient is primary and spouse is secondary

A husband and wife both have insurance coverage that overlaps through their employers. The wife comes in to be seen. This insurance is considered her primary.

social and alpha character

a Medicare patient's health insurance claim number is comprised of these?

shorter turn around time, decreased prep time

what are the advantages of processing claims electronically?

costs less and is more comprehensive

what are the benefits of group health insurance?

utilization review

a review by allied health professionals at predetermined times to assess the necessity of the patient remaining in an acute care facility

indemnity

this insurance allows patients to choose their provider and see specialists without referrals?

2005

The year Medicare began providing coverage for one routine physical exam per year

businesses with less than 10 FT employees including phys

The only practitioners that can currently bill Medicare with the hard copy of CMS-1500 form are?

confidentiality

If information is given to a third party without the signed authorization of the patient, the one who gave the information may be charged with breach of this?

workers compensation WC

a government program that provides insurance coverage for people injured on the job or who have developed work-related disorders, disabilities, or illnesses

managed care

these plans integrate the financing and appropriate delivery of services to covered persons by contracting providers for comprehensive health care services, with specific standards for the providers' specialty, and maintaining programs for quality assurance and utilization review.

welcome to medicare

this is a type of physical Medicare pays for?

pay close attention to all necessary details when preping forms

How you can ensure prompt payment?

fee schedule

Usually, the physician agrees to treat people enrolled in the program for an agreed this?

workers compensation WC

Employees in the US have the benefits of being covered by these laws if injured while working or becoming ill as a result of work.

annually

the two standard non-menclature code books (ICD and CPT) are published this often and are absolutely essential to the function of the medical office

to cover hosptial expenses

the reason why Blue Cross was originally set up?

medical office

Who is mainly responsible for filing claims

med care, temp disability, perm disability, family pay fatal injury

Four types of benefits under WC
-pt can be seen in our out of hospital for med care
-temporary disability, week or monthly cash benefits and med care
-perminant disability, cash benefits and med care possible lump sum
-family member pay if fatal injury

indemnity

has the least amount of structural guidelines for patients to follow

annual exams and physicals

HMOs focus on these to promote health maintenance?

on their company website online

insurance companies usually publish their provider directories here

birthday rule, according to parents birthday first on calander year

When a child is covered by two insurance policies (one from each parent) you follow this rule (explain it as well)

medicaid

health coverage for the medically indigent?

PPOs

These type of insurance plans usually have deductibles and copayment requirements and the office usually files claims for services rendered?

HMO takes the place of traditional

If a patient has a Medicare HMO they cannot also have traditional Medicare. Why?

contain cost

what is the primary purpose of HMOs?

reimbursment rates

reasons why physicians opt not to see Medicaid patients?

annually

how often are physicians required to register with the state WC board?

2001

When were all Medicare claims required to be submitted electronically?

reason rule

this rule states that the reason for a patients visit is coved first?

no

Your physician accepts Medicaid patients. Does he have to accept Medicaid HMO patients?

non covered charge or service

physicians only have to notify Medicare patients of charges for this reason?

history, exam, medical decision, counseling, coordination of care, nature of presenting problem, time spent

what are the 7 components used in defining the levels of e/m services?

e&m, anesthesiology, surgery, radiology, pathology & labs, medicine

what are the six sections in which hte main body of the CPT codes are listed?

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