50 terms

Medical Office Management

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A bed patient in a hospital is called
inpatient
A person who represents either party of an insurance claim is the
adjuster
A request for payment under an insurance contractor bond is called
claim
Payment made periodically to keep an insurance policy in force is called
premium
A person or institution that gives medical care is
provider
Benefits that are made in the form of cash payments are known as
indemnities
An amount the insured must pay before policy benefits begin is called
deductible
An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider is called
health maintanance organization
Health insurance that provides protection aginst the high cost of treating severe or lengthy illnesses or disabilities is called
catastrophic
A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called
outpatient
An injury that prevents a worker from performing one or more of the regular functions of his job would be known as a
partial disability
A previous injury , disease or physical condition that existed before the health insurance policy ws issued is called
preexisting condition
One who belongs to a group insurance plan is called
subscriber
A sum of money provided in an insurance policy, payable for covered services is called
benefits
To prevent the insured from receiving a duplicate payment for losses under more than one insurance policy is called
coordination of benefits
When a patient has health insurance, the percentage of covered services that is the responsiblity of the patient to pay is known is
coinsurance
Insurance that is meant to offset medical expenses resulting from a castastrophic illness is called
major medical
An unexpected event which may cause injury called
accident
A doctor who agrees toaccept an insurance compaines pre-established fee as the maximum amount to be collected is called
participating physician
Insurance plans that pay a physician's full charge if it does no exceed his normal charge or does not exceed the amount normally charged for the service is called
usual, customary and reasonble
A notice of insurance claim or proof of loss must be filed within a designated or
time limit or it can be denied
A health program for people age 65 and under social security is called
Medicare
A civilian health and medical program of the uniform services is called
Tri-care
A form of insurance paide by the employer provideing cash benefits to workers injured or disabled in the course of employment is called
Workers's compensation
A recap sheet that accompaines a Medicare or Medicaid check, showing breakdown and explaination of payment on a claim is called
explaination of benefits
A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called
co-payment
In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison with a limited clause is called
comprehensive
A rider added to a policy to provide additional benefits for certain conditions is called
dread disease rider
An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect is called
grace period
An agreement by which a patient assigns to another party the right to recieve payment from a third party for the service the patient has recevied is called
assignment of benefits
A skilled nursing facility for patients receiving specialized care after discharge from a hospital is called
extended care facility
Payment for hospital charges incurred by an insured person because of illness is called
hospital benefits
An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policy holder for the insurer is called
insurance agent
A method of charging whereby a physician presents a bill ofr each service rendered is call
fee-for-service
The Tri-Care fiscal year is from
October 1 to September 30
The number on the Employees Withholding Exemption Certificate is
W-4
FICA
social security
As part of the office bookkeeping procedures, the physician's bank statement should be reconciled with the
checkbook
A record of deits, credits, and balances is referred to as a patients
ledger
A signature o the revers sisde of a check is call
endorsement
A form to itemize deposits made to savings or checking accounts is called
deposit slip
To correct a handwritten error in patient's chart , is only acceptable to
draw a line through the error, insert the correct information, date and initial it
Low income patients can be covered by what type of insurance?
Medicaid
The reference procedural code book that uses a numbering system developed by the AMA is called
current procedural terminology
Pre-certification
is a method used for determinin whether a particular service or procedure is covered under a patient's policy.
The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is
diagnosis
In insurance coding using and "E" code designates
classification of enviornmental events, such as poisoning
E/M codes are located in the
CPT manuel
Which codes can modifiers be added to, to indicate that procedure or service has been altered in some way?
CPT
The CMS-1500
form is used by non-institutional provideres and suppliers to bill Medicare, Part B covered services.
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