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medical manager final
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Terms in this set (60)
adjustments
to keep the doctors books and tyhe patients ledger in balance any change in the original charge must be accounted for. a finished entry called an adjustment is used to increase or decrease the initial charge amount
batch
a group of changes or payments posted in one session, or a group of insurance claims transmitted together electronically
claim form
this is the document sent to the insurance company to request payment for services that were performed for the patient
cpt-4
stands for current procedural terminology, a standard medical coding system developed by the american medical association
daily close
an end of day report detailing all of the transactions that were posted durning the day is also similar to a day sheet or daily log
debit
is an accounting term thats means to increase an amount
double book
this is the practice scheduling more patients than the physicians can see during a reasonable period of time
electronic media claims
this refers to electronic claims that are sent over the telephone, using a modem
fee schedule
a schedule of defined charges that a provider can use when billing
guarantor
this is the person who agrees to be financially responbsible for the account
health maintenance organization
a group of physicians usually operating within one facility
icd-9
international classification of diseases 9th edition published by the american medical association
insurance id number
an identification number is assigned by the insurance company to identify a particular insurance policy, also known as subscriber, policy #, id (insurance)#
major medical insurance
this is sometimes called catastrophe insurance because it is designed to help offset huge medical exspenses that result from a lengthy illness of serious accident
medicaid
this is financial assistance program sponsored jointly by the federal government and the states to provide health care for the poor
medicare
this is an insurance program sposored by the federal government to protect the elderly and disabled population
modifier
this is a two digit code added to a procedure code including why the procedure is not being charged at its normal fee
outpatient
a patient who receives in depth medical treatment, such as a surgical procedure, from a facility such as a hospital but not required to stay at the facility overnight
patient number
this is a unique number assigned to every patient at the time he or she is entered into the system during new patient entry
policy holder
this is the individual who owns the insurance policy
authorization
an authorization form signed by the patient or official request from and authorized government agency to provide patient health information for purposes other than treatment, payment or official
bill type
two numeric characters that tell the company the type of bill a patient receives
champva
a government insurance program for veterans and their dependents
coverage
the treatment or services the insurance plan will agree to allow for a patient
deductable
this is the amount the patient is expected to pay before the insurance plan will begin paying
disability
a condition that prevents the patient from being able to perform certain activities
emc billing
producing insurance claims electronically
facility
a provider of services such as a laboratory or hospital
group name
this is a field on the insurance policy screen that allows you to specify who the group policy belongs to
health insurance portability and accountability act
federal legislation intended to improve portability and continuity of health insurance coverage
inpatient
a person who is required to stay at a facility overnight for in depth medical treatment
insured party
this is the person in whose name the insurance coverage is held
malpractice
this is a term used to indicate that the treatment a physician provided to a patient was incorrect or improper
medicare adjustment
a medicare adjustment lowers the physicians charge to the amount that medicare approves
negative adjustment
this type of adjustment allows money that has been allocated to individual open itmes on a patients account to be removed from that item
open items
this refers to charges that were posted previously but have not yet been paid in full or adjusted off the account
pos
place of service, this is a series of standardized codes that indicate where the doctor saw the patient or performed the procedure
primary care physician
this is a doctor who has contracted with a managed care plan and has agreed to be responsible for providng the health care for specific patients participating in the plan
reimbursement
payment of a medical claim
responsible party
the person or the organization responsible for paying part or all of the patients bill
consent
under hippa privacy rules, the patient give consent to the use of his or her protected health information by the medical practice for purposes of treatment
credit
an accounting term that means to lower an amount
diagnosis code
the physicians determination of what is wrong with each patient is called the diagnosis
explanation of benefits
this is an insurance company document that accompanies payment(or explains the lack of payment) for a particular patients charges
insurance claim
most people have health insurance that pays all or a portion of expsenses incurred when they have an illness or injury, an insurance claim form must be completed and filed with the insurance company before reimbursment will be made
medicare approved amount
the maximum amount that a medicare participating provider may collect for perfoming a procedure
narrative
text written by the physician about the patient that includes items such as patient history, subjective and objective findings, and recommendations
overbooking
is the practice of scheduling more patients than the physician can see during a reasonable period of time
preferred provider organization
an organization of physicians participating in a plan. generally ppo plans allow the patient to see a participating physician or a nonparticipating physician of his or her choice
procedure
the service performed by the doctor
procedure code
the services the doctor provides to a patient are called procedures and are indentified by a procedure code
provider
any health care specialist rendering service
tricare
a government insurance program for military personnel and their dependents
units
this refers to the number of times the procedure was repeated durning the date or dates of service
voucher
the check or other type of payment that is used to pay an account
workers compensation
this is a insurance that covers medical expenses incurred as a result of work-related injury or disability
type of service
this is a series of standardized codes that indicate the type service performed for the patient (e.g..medical care, surgery)
statement
bill sent by the doctor to each patient or family detailing the servies rendered
system date
this is the date set within the medical manager system
split check
this refers to a check that includes payment for more than one guarantors account
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