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Medical Billing Mod 1 Chapt 1

Terms in this set (33)

accounting cycle
the flow of financial transactions in a business
accounts receivable (AR)
monies that are flowing into a business
adjustication
series of steps that determine whether a claim should be paid
capitation
payment to a provider that covers each plan memeber's health care servicesfor a certain period of time
coding
the process of translating a description of a diagnosis or procedure into a standardized code
coinsurance
percentage of change that an insured person must pay for health care services after payment of the deductible amount
consumer-driven health plan (CDHP)
a type of managed care in which a high-deductible, low premium insurance plan is combined with a pretax saving account to cover out0of-pocket medical expenses
copayment
a fixed fee paid by the patient at the time of an office visit
deductible
amount due before benefits
diagnosis
physician's opinion of the nature of the patient's illness or injury
diagnosis code
a standardized value that represents a patient's illness, signs, and symptoms
documention
a record of health care encounter between the physican and the patient, created by the provider
electric health record (EHR)
a computerized lifelong health care record for an individual that incorporates data from providers who treat the individual
encounter form
a list of the procedures and charges for a patient's visit
explanation of benefits (EOB)
paper document from a payer that shows how the amount of a benefit was determined
fee-for-service
health plan that repays the policyholder for covered medical expenses
health maintenance organization (HMO)
a managed health care system in which providers agree to offer health care to the organization's member 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 the delivery of health care
medical coder
a person who analyzes and codes patient diagnosis, procedures, and symptoms
medical necessity
treatment provided by a physican to a patient for the purpose of preventing, diagnosis, or treating an illness, injury, or its symptoms in a manner that is appropriate and ith generally accepted standards of medical practice
medical record
a chronological record of patient's medical history and care that includes information that the patient provides, as well as the physican's assessment, 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
a form that includes a patient's personal, employment, and insurance data needed to complete an insurancce claim
payer
private or government organization that insures or pays for health care on behalf of beneficiaries
policyholder
a person or entity 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
preferred provider organization (PPO)
managed care network of health care providers who agree to preform services for plan members at discounted fees
premium
the periodic amount of money the insured pays to a health plan for insurance coverage
procedure
medical treatment provided by physician or other health care provider
procedure code
a code that identifies a medical serivce
remittance advice (RA)
an explanation of benefits transmitted electronically by a payer to a provider
statment
a list of all services performed for a patient, along with the changes for each service
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