CHAPTER 1 MEDICAL OFFICE
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33 terms
Terms | Definitions |
|---|---|
 POLICYHOLDER | A PERSON OR ENTITY WHO BUYS AN INSURANCE PLAN: THE INSURED |
| HEALTH PLAN | A PLAN, PROGRAM, OR ORGANIZATION THAT PROVIDES HEALTH BENEFITS |
| PREMIUM | THE PERIODIC AMOUNT OF MONEY THE INSURED PAYS TO A HEALTH PLAN FOR INSURANCE COVERAGE |
| PAYER | PRIVATE OR GOVERNMENT ORGANIZATION THAT INSURES OR PAYS FOR HEALTH CARE ON BEHALF OF BENEFICIARIES |
| FEE-FOR-SERVICE | HEALTH PLAN THAT REPAYS THE POLICYHOLDER FOR COVERED MEDICAL EXPENSES |
| DEDUCTIBLE | AMOUNT DUE BEFORE BENEFITS START |
| COINSURANCE | PERCENTAGE OF CHARGES THAT AN INSURED PEROSN MUST PAY FOR HEALTH CARE SERVICES AFTER PAYMENT OF DED. AMOUNT |
| MANAGED CARE | A TYPE OF INSURANCE IN WHICH THE CARRIER IS REPONSIBLE FOR BOTH THE FINANCING AND THE DELIVERY OF HEALTH CARE |
| PREFERRED PROVIDER ORGANIZATION (PPO) | MANAGED CARE NETWORK OF HEALTH CARE PROVIDERS WHO AGREE TO PERFORM SERVICES FOR PLAN MEMBERS AT DISCOUNTED FEES |
| HEALTH MAINTENANCE ORGANIZAION (HMO) | A MANAGED HEALTH CARE SYSTEM IN WHICH PROVIDERS AGREE TO OFFER HEALTH CARE TO THE ORGANIZATIONS MEMBERS FOR FIXED PREMIUMS |
| CAPITATION | PAYMENT TO A PROVIDER THAT COVERS EACH PLAN MEMBERS HEALTH CARE SERVICES FOR A CERTAIN PERIOD OF TIME |
| COPAYMENT | A FIXED FEE PAID BY THE PATIENT AT THE TIME OF AN OFFICE VISIT |
| CONSUMER-DRIVEN HEALTH PLAN (CDHP) | A TYPE OF MANAGED CARE IN WHICH A HIGH-DEDUCTIVLE, LOW PREMIMUM INSURANCE PLAN IS COMBINED WITH A PRETAX SAVINGS ACCOUNT TO COVER OUT OF POCKET MEDICAL EXPENSES |
| PATIENT INFORMATION FORM | A FORM THAT INCLUDES A PATIENTS PERSONAL, EMPLOYMENT AND INSURANCE DATA NEEDED TO COMPLETE A INSURANCE CLAIM |
| DOCUMENTATION | A RECORD OF HEALTH CARE ENCOUNTERS BETWEEN THE PHYSICIAM AND THE PATIENT, CREATED BY THE PROVIDER |
| MEDICAL RECORD | A CHRONOLOGICAL RECORD OF A PATIENTS MEDICAL HISTORY AND CARE THAT INCLUDES INFORMATION THAT THE PATIENTS PROVIDES AS WELL AS THE PHUSICIANS ASSESSMENT, DIAGNOSIS AND TREATMENT PLAN |
| DIAGNOSIS | PHYSICIANS OPINION OF THE NATURE OF THE PATIENTS ILLNESS OR INJURY |
| PROCEDURE | MEDICAL TREATMENT PROVIDED BY A PHYSICIAN OR OTHER HEALTH CARE PROVIDER |
| CODING | THE PROCESS OF TRANSLATING A DESCRIPTION OF A DIAGNOSIS OR PROCEDURE INTO A STANDARDIZED CODE |
| DIAGNOSIS CODE | A STANDARDIZED VALUE THAT REPRESENTS A PATIENTS ILLNESS, SIGHN, AND SYMPTOMS |
| PROCEDURE CODE | A CODE THAT IDENTIFIES A MEDICAL SERVICE |
| MODIFIER | A 2 DIGIT CHARACTER THAT IS APPENDED TO A CPT CODE TO REPORT SPECIAL CIRCUMSTANCES INVOLVED WITH PROCEDURE OR SERVICE |
| ENCOUNTER FORM | LIST OF PROCEDURES AND CHARGED FOR A PATIENTS VISIT |
| ELECTRONIC HEALTH RECORD (EHR) | COMPUTERIZED LIFELONG HEALTH CARE RECORD FOR AN INDIVIDUAL THAT INCORPORATES DATA FROM PROVIDERS WHO TREAT THE INDIVIVUAL |
| PRACTICE MANAGEMENT PROGRAM (PMP) | SOFTWARE PROGRAM THAT AUTOMATES MANY OF THE ADMINISTRATIVE AND FIANANCIAL TASKS IN A MEDICAL PRACTICE |
| MEDICAL CODER | PEROSN WHO ANALYZES AND CODES PATIENT DIAGNOSES, PROCEDURES AND SYMPTOMS |
| MEDICAL NECESSITY | TREATMENT PROVIDED BY A PHYSICAN TO A PATIENT FOR THE PURPOSE OF PREVENTING, DIAGNOSING OR TREATING AN ILLNESS, INJURY OR ITS SYMPTOMSIN A MANNER THAT IS APPROPRIATE AND IS PROVIDED IN ACCORDANCE WITH GENERALLY ACCEPTED STANDARDS OF MEDICAL PRACTICE |
| ADJUDICATION | SERIES OF STEPS THAT DETERMINE WHETHER A CLAIM SHOULD BE PAID |
| REMITTANCE ADVICE (RA) | EXPLANATION OF BENEFITS TRANSMITTED ELECTRONICALLY BY A PAYER TO A PROVIDER |
| EXPLANATION OF BENEFITS (EOB) | PAPER DOCUMENT FROM A PAYER THAT SHOWS HOW THE AMOUNT OF A BENEFIT WAS DETERMINED. |
| STATEMENT | LIST OF ALL SSERVICES PERFORMED FOR A PATIENT, ALONG WITH THE CHARGES FOR EACH SERVICE |
| ACCOUNTING CYCLE | THE FLOW OF FINANCIAL TRANSACTIONS IN A BUSINESS |
| ACCOUNTS RECEIVABLE (AR) | MONIES THAT ARE FLOWING INTO A BUSINESS INTO A BUSINESS |
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