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chapter 1 vocabulary

Terms in this set (32)

accounting cycle
the flow of financial transactions in a business for making sales to collecting payments for the goods of services delivered
accounts recievable
monies that are coming into the practice and produce financial reports
adjudication
a series of steps designed to judge whether a claim should be paid
capitation
fixed payments
coding
the process of translating a description of a diagnosis or procedure into standardized code
coinsurance
the portion of charges that an insured person must pay
consumer driven health plan (CDHP)
type of managed care insurance in which a high deductible low premium insurance plan is combined with a pretax savings account to cover out of pocket medical expenses
co-payment
a fixed fee, such as 20.00 @ the time of an office visit
deductible
amount due before benefits begin-must be paid
diagnosis
physicians opinion of the nature of the pt's illness or injury
diagnosis code
a standardized value that represents a pt's illness,signs,and symptoms
documentation
a record of health care encounters between the physician and pt created by the provider
Electronic Health Record (EHR)
a computerized lifelong health record for an individual that incorporates data from providers who treat the individual
encounter form
a list of procedures and charges for a pt's visit
explaination of benefits ( EOB)
paper document from a payer that shows how the amount of a benefit was determined
fee-for-service
plan that repays the policy holder for covered medical expenses
HEALTH MAINTENCE ORGANIZATION (HMO)
a managed health care system in which providers agree to offer health care to organizations members for fixed payments
health plan
a plan, program or organization that provides health benefits
MANAGED CARE
a type of insurance in which the carrier is responsible for both the financing and delivery of health care benefits
Medical coder
a person who analyzes and codes pt's diagnosis, procedures, and symptoms
Medical necessity
treatment provided by a physician to a pt for the purpose of preventing, or treating an illness, injury or its symptoms
medical record
chronological record of pt's medical history and care that includes info that the pt's provide as well as the physicians assessments, diagnosis, and treatment plan
Modifier
a two-digit character that is appended to a CPT code to report special circumstances involved with a procedure or service
Patient information form
form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim.
Payer
private or government organization that insures or pays for health care on the behalf of beneficiaries
Policy Holder
a person who buys an insurance plan; the insured
Practice Management Program (PMP)
a software program that automates many of the administrative and financial tasks in a medical practice
Premium
The periodic amount of money the insured pays to a health plan for a health care policy.
Procedure
medical treatment provided by a physician or other health care provider
procedure code
A code that identifies a medical service
Remittance Advice
an explanation of benefits transmitted electronically by a payer to a provider.
Statement
a list of all services performed for a patient, along with the charges for each service
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