1.
Abuse: Incidents pr practices not usually considered fraudulent, that are inconsistent with accepted medical business or fiscal practices.
2.
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.
3.
Authorization Form: An individual's formal written permission to use or disclose his or her protected health information
4.
Code Set: Any set of codes with their descriptions used to encode data elements
5.
Compliance: acting according to certain accepted standards
6.
Confidentiality: the act of holding information in confidence, not to be released to unauthorized individuals
7.
Daysheet: daily business record of charges and payments
8.
Eligibility: Qualifying factors that must be met before a patient receives benefits under a specified insurance plan, government program, or managed care plan.
9.
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.
10.
Ethics: The principles of right and wrong that guide and individual in making decisions(they are not laws).
11.
Etiquette: rules governing socially acceptable behavior
12.
Exclusions: exceptions to insurance coverage
13.
Fraud: a deliberate deception intended to produce unlawful gain
14.
Guarantor: An individual who promises to pay the medical bill
15.
Health Insurance: a plan in which private companies or government programs pay for part or all of a person's medical costs
16.
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.
17.
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.
18.
Insured: a person whose interests are PROTECTED by an insurance policy
19.
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
20.
Phantom Billing: Billing for services not performed
21.
Preauthorization: Determination off whether or not a particular treatment is MEDICALLY NECESSARY and covered by the insurance policy; required by many insurance companies
22.
Precertification: finding out if a particular type of service is covered by this insurance plan--COVERAGE
23.
Predetermination: Determination of the potential DOLLAR AMOUNT the insurance company will pay for a particular treatment.
24.
Premium: The periodic amount of money the insured pays to a health plan for a health care policy.
25.
Privacy: The condition of being secluded from the presence or view of others
26.
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.
27.
Standard: A rule, condition or requirement
28.
Subscriber: the person who has been insured; an insurance policy CONTRACT HOLDER
29.
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.
30.
Verification: The act of proving to be true, exact, or accurate.
