ICBS110 Week1
About this set
Created by:
JoDeVera on May 21, 2011
Subjects:
medical insurance coding & billing
Classes:
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30 terms
Terms | Definitions |
|---|---|
 Confidentiality | the act of holding information in confidence, not to be released to unauthorized individuals |
| Ethics | The principles of right and wrong that guide and individual in making decisions(they are not laws). |
| Etiquette | rules governing socially acceptable behavior |
| Compliance | acting according to certain accepted standards |
| HIPAA Title I | Insurance reform--The purpose is to provide continuous insurance coverage for workers and their insured dependents when they change or lose their job. |
| HIPAA Title II | Administrative Simplication--Aims to standardize the electronic transmission. Additional provisions are meant to ensure privacy and security of an individual's health data. |
| Abuse | Incidents pr practices not usually considered fraudulent, that are inconsistent with accepted medical business or fiscal practices. |
| Fraud | a deliberate deception intended to produce unlawful gain |
| Phantom Billing | Billing for services not performed |
| Privacy | The condition of being secluded from the presence or view of others |
| Standard | A rule, condition or requirement |
| Code Set | Any set of codes with their descriptions used to encode data elements |
| Verification | The act of proving to be true, exact, or accurate. |
| Mitigation | Reasonable steps taken in response to a breach of security or confidentiality to lessen any harmful effects the breach may have upon the patient |
| Eligibility | Qualifying factors that must be met before a patient receives benefits under a specified insurance plan, government program, or managed care plan. |
| Daysheet | daily business record of charges and payments |
| Assignment | An agreement by which a patient assigns to another party the right to receive payment from a third party for the services the patient has received. |
| Authorization Form | An individual's formal written permission to use or disclose his or her protected health information |
| Guarantor | An individual who promises to pay the medical bill |
| Emancipated Minor | Person younger than 18 years of age who lives independently, is totally self-supporting, is married or divorced, is a parent even if not married, or is in the military and possesses decision-making rights. |
| Preauthorization | Determination off whether or not a particular treatment is MEDICALLY NECESSARY and covered by the insurance policy; required by many insurance companies |
| Precertification | finding out if a particular type of service is covered by this insurance plan--COVERAGE |
| Predetermination | Determination of the potential DOLLAR AMOUNT the insurance company will pay for a particular treatment. |
| Premium | The periodic amount of money the insured pays to a health plan for a health care policy. |
| Subscriber | the person who has been insured; an insurance policy CONTRACT HOLDER |
| Insured | a person whose interests are PROTECTED by an insurance policy |
| Privileged Information | Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained. |
| Exclusions | exceptions to insurance coverage |
| Health Insurance | a plan in which private companies or government programs pay for part or all of a person's medical costs |
| Transaction | Under HIPAA a structured set of data transmitted between two parties to carry out financial or administrative activities related to health care in medical billing program a financial exchange that is recorded such as a patients copayment or deposit of funds into the providers bank account. |
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