ch. 16 health insurance
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18 terms
Terms | Definitions |
|---|---|
 Billing services | companies that offer services to health care facilities that include billing processes and claims filing. |
| Code sets | data elements used to document uniformly the reasons why patients are seen, procedures and services are provided to them during their health care encounters. |
| Direct data entry claims | claims that are submitted directly to an insurance carrier. |
| Electronic claims clearinghouse | a business entity that receives claims from several medical facilities and consolidates these claims so that one transmission containing multiple claims can be sent to each insurance carrier. |
| Electronic Data interchange | the electronic transfer of information in a standard format between two entities. Allows business entities to exchange information and transact business in a rapid and cost effective way. |
| Electronic medical record | An electronic file wherein patient's health information is stored in a computer system. |
| Identifiers | The numbers used in the administration of health care to distinguish individual health care providers, health plans, employers, and patients. |
| Privacy standards | Intended to define what are appropriate and inappropriate disclosures of individually indentifiable health information, and how patient rights are to be protected. |
| Small providers of services | A hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation, facility, home health agency, or hospice program with less that 25 full-time equivalent employees. |
| Telecommunication | The transmission of claim information over phone lines using a computer and a modem. the most common form of electronic claim transmission. |
| privacy | is the basic concern of EMRs |
| information management | one of the most significant activities of the healthcare industry |
| e-mailing | transmitting free-format textual electronic messages from one individual to another |
| Computer modem hipaa compliant software | To send claims electronically, the medical practice needs |
| ASCA | The acronym for the organization enacted by congress to improve the administration of Medicare by taking advantage of the efficiencies gained through electronic claims submission |
| 1960s | electronic transmission began in the >? |
| HIPAA | The organization created to reform health insurance and simplify the healthcare administrative process is known as? |
| enrollment process | if a medical practice chooses to submit claims electronically to an insurance carrier, it must go through> |
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