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MOD 170 Unit 3
Terms in this set (50)
a tool that, when used efficiently, helps one to organize the daily schedule of the dental practice.
Feature used in appointment books to identify the current week so that it can be turned to quickly.
Organized list that identifies patients who need to be schedule for dental treatment, who can come in when there is a change in the schedule, or who wish to be notified when an opening in the schedule occurs.
Division of the pages of an appointment book.
A computerized version of the manual appointment book.
Fees charged for dental treatment, or monies collected.
Time segment into which appointment book divide the day.
Automated Recall Systems
System involving the use of an electronic database to identify and track recall patients.
Scheduled appointment for preventive treatment or reevaluation of dental conditions.
Mail Recall System Back Order
System that requires the mailing of recall cards to patients to remind them that they are due in the dental office for an appointment
Items used only once and then thrown away.
Supplies and products that can be reused for a specific length of time before they have to be replaced.
The time it takes for supplies to arrive at the office once an order has been placed.
Non Consumable Products
Items that can be used for only 1 or 2 years before they must be replaced because of wear.
Account Aging Reports
Report that identifies the length of time that has elapsed since a charge was made.
A tool used to gather credit information.
Divided Payment Plan
Plan in which payments are divided according to the length of treatment.
Insurance Billing Plans
Types of payments plans that have established policies that must be followed.
Maximum amount paid for each procedure by the insurance company.
Assignment of Benefits
Authorization given by the subscriber or patient to a dental benefit plan, directing the company to make payment for dental benefits directly to the providing dentist.
Method used to determine which parent is considered the primary provider o a child's dental coverage.
Billing the patient for the difference between the amount paid by the dental benefits plan and the fee charged by the dentist.
Amount paid by the dental benefits plan.
Programs in which the dental practice is paid a set amount for each patient who is enrolled in the program.
Coordination of Benefits
System that coordinates the benefits of two or more insurance policies.
Type of dental facilities that are owned and operated by companies for the purpose of providing dental care tot heir employees and dependents
Fee, as determined by the third party administrator, from actual submitted fees, for specific dental services.
Service fee that the patient is responsible for paying before the third party will consider payment of additional services.
Payment plan that allows an organization to be self-funded for the purpose of providing dental benefits.
Method of changing a reported benefits code by third-party payers so as to reflect a lower cost procedure.
Dual Choice Program
An insurance policy that provides the eligible individual the choice of an alternative dental benefit program or a traditional dental benefit program.
The effective date of dental coverage
List of charges for services and procedures
Rule that determines the primary and secondary coverage of the child by assigning primary coverage to the father and secondary to the mother.
Dental benefit plan that utilizes schedules of allowances, ables for allowances, or resonable and customary fee schedules as the bases of payment calculations
The total amount of benefits that will be paid toward services and procedures
The total amount of benefits that will be paid for an individual or family for services and procedures
Maximum Fee Schedule
The total acceptable fee for a service or procedure that will be charged by a provider under a specific plan.
The brief literal definition provided with each procedure code
Period of time when a member of a benefits program has the option of selecting the type of coverage and the provider of services
Billing of benefits for procedures that results in highter payments than are justified by the service or procedure provided
Certification by a benefit plan that a pretreatment plan has been authorized for payment in accordance with the patient's group
Prefiling of Fees
A procedure in which a provider files a fee schedule with the benefit plan organization for the purpose of gaining preauthorization of the fee schedule
Documents used to communicate information contained on an insurance claim form
Table of Allowance
A list of services and procedures that a benefits plan will pay for, with dollar amounts assigned to each procedure
A dental professional who is not under contract with a dental benefits plan
Usual, Customary and Reasonable Plan (UCR)
A dental plan that uses the following criteria to establish a fee schedule: usual fee, the fee the dentist uses most often for a given dental service; customary fee, the fee determined by the third party administrator from actual submitted fees for specific dental services; and reasonable fee, a determination
Claims Payment Fraud
Changing or manipulating of information on a claim form that results in payment of a lower benefit to the treating physican
Method used by third parties to check the accuracy of claim forms by comparing patient clinical records with information submitted on the claim form
THIS SET IS OFTEN IN FOLDERS WITH...
unit 3 Mod 170 theory
MOD 170 Unit 4
MOD 170 Unit 1
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