MOD 170 Unit 4

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50 terms · Medical Terminology

Actuarial statistics

studies that an insurance company uses.

benefit

an item covered by an insurance policy, or something paid to or on the behalf of recipient

compensatory

monetary compensation for physical impairment,pain and suffering, loss of earnings, or additional medical expenses as a result of the negligence.

insurance speculation

buying insurance or coverage for the purpose of making a profit.

reinsurance

an insurance that would reimburse the employer when losses exceed a specific amount

stoploss insurance

insurance that covers plans when their benefit payments exceed a certain amount

aggregate

any amounts paid toward the deductible by any member of the family will be added up to reach any deductible

beneficiary

person entitled to benefits or proceeds of an insurance policy or will

carryover deductible

any amounts which the patient pays toward their deductible in the last three months of the year will carry overy and will be applied to the next year's deductible

coinsurance limit

stipulates that if the coinsurance portion of a patient's bills reaches a certain amount, all subsequent claims will be paid at 100% of the allowed amount

credible coverage

like or similar charges

subrogation

the right for a portion of the recovery that the claimant may obtain from a third party

common accident provision

States that only one deductible, under Major medical, will be taken for all members of family involved in the same accident.

conversion factor

Dollar value of each unit. Each 3rd party payer issues a list of conversion factors which varies from one region to another. This is multiplied by the number of units in the procedure.

fee schedule

allowable amount for that particular procedure assigned according to the particular CPT code

precertification

preapproval for admission on elective, nonemergency hospitalization

predetermination

an estimate of maximum benefits that may be paid under the plan for the service

unnecessary surgery

surgery recommended as an elective procedure when an alternative method of treatment may be preferable

concurrent review

determines whether the estimated length of time & scope of the inpatient stay is justified by the diagnosis & Symptoms.

batch files

files which are kept in batches or groups based on the date they were processed and the person who processed them

claim files

files for holding claims and other processing information

full credit adjustment

an adjustment that completely reverses a claim payment

gender rule

states that the plan covering the male employee is primary, and the plan covering the female employee is secondary

global COB

COB applied to both medical and dental charges combined

partial credit adjustment

an adjustment that partially reverses a claim payment

colp/o

vagina.

culdocentesis

surgical puncture to remove fluid from the cul-de-sac

cystocele

hernia in which the urinary bladder protrudes through the wall of the vagina

D & C

dilation & curettage

endometriosis

the presence of endometrium elsewhere than in the lining of the uterus

genital

of or relating to the external sex organs

gynec/o

woman, female

hyster/o

uterus, womb

hysterotomy

surgical incision into the uterus (as in cesarean section)

IUD

intrauterine device; contraceptive

oophorectomy

surgical removal of one of both ovaries

anarchism

a political theory favoring the abolition of governments

artificial insemenation

to insemenate with pre sperm

azoospermia

absence of sperm in the semen

balanitis

inflammation of the head of the penis

BPH

benign prostatic hyperplasia/hypertrophy

castrate

a man who has been castrated and is incapable of reproduction

orchid

testes

orchidectomy

surgical removal of one or both testicles

phimosis

an abnormal tightness of the foreskin preventing retraction over the glans

prostatis

inflammation of the prostate

PSA

a protein manufactured exclusively by the prostate gland

spermat/o

spermatozoa, sperm cells

spermicide

a contraceptive agent that kills spermatozoa

TURP

transurethral resection of the prostate

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