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Medisoft Chp 1 Terms

Terms in this set (33)

accounting cycle
the flow of financial transactions in a business
accounts receivable
monies that are flowing into a business
adjudication
series of steps that determine whether a claim should be paid
capitation
payment to a provider that covers each plan member's health care services for a certain period of time
coding
the process of translating a description of a diagnosis or procedure into a standardized code
coinsurance
percentage of charges that an insured person must pay for health care services after payment of the deductible amount
consumer-driven health plan
a type of managed carein which a high-deductible, low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses
copayment
a fixed fee paid by the patient at the time of an office visit
deductible
amount due before benefits start
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
documentation
a record of health care encounters between the physcian and the patient, created by the provider
electronic health record
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
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
a managed health care system in which providers agree to offer health care to the organization's 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 the delivery of health care
medical coder
a person who analyzes and codes patient diagnoses, procedures, and symptoms
medical necessity
treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and is provided in accordance with generally accepted standards of medical practice
medical record
a chronological record of a patient's medical history and care that includes information that the patients provides, as well as the physician'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 of service
patient information form
a 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 behalf of beneficiaries
policyholder
a person or entity who buys an insurance plan; the insured
practice management program
a software program that automates many of the administrative and financial tasks in a medical practice
preferred provider organization
managed care network of health care providers who agree to perform services forplan 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 a physician or other healthcare provider
procedure code
a code that identifies a medical service
remittance advice
an explanation of benefits transmitted 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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