Chapter 1 & 2 (MOS)

17 terms by elle1340

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Accounting Cycle

The flow of financial transactions in a business.

Clearinghouse

A company that receives claims from a provider, prepares them for processing, and transmits them to the payers in HIPAA-compliant format.

Encounter Form

A list of the procedures and charges for a patient's visit.

Diagnosis Code

A standardized value that represnts a patient's illness, signs, and sympotms.

payer

Private or government organization that insures or pays for health care on behalf of beneficiaries.

Copayment

A fixed fee paid by the patient at the time of an office visit.

Capitation

Payment to a provider that covers each plan memeber's health care services for a certain period of time.

Fee-for-service

Health plan that repays the policyholder for covered medical expenses.

Accounts Receivable

Monies that are flowing into a business.

ICD-9 code

Identifies the diagnoses code

Premium

payment or reward (especially from a government) for acts such as catching criminals or killing predatory animals or enlisting in the military

Managed Care

A system that combines the financing and the delivery of appropriate, cost-effective health care services to its members.

Explanation of Benefits

A recap sheet that accompanies an insurance checks showing the breakdown and explanation of payments on a claim.

Audit/edit Report

a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer

Preferred Provider Organization

A managed care organization structured as a network of health care providers who agree to perform services for plan members at discounted fees; usually, plan members can receive services from non-network providers for a higher charge.

Patient Information Form

Form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim.

National Provider Identifcation Number

10 digit number that every insurance company has.

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