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17 terms

Chapter 1 & 2 (MOS)

STUDY
PLAY
Accounting Cycle
The flow of financial transactions in a business.
Clearinghouse
A company that receives claims from a provider, prepares them for processing, and transmits them to the payers in HIPAA-compliant format.
Encounter Form
A list of the procedures and charges for a patient's visit.
Diagnosis Code
A standardized value that represnts a patient's illness, signs, and sympotms.
payer
Private or government organization that insures or pays for health care on behalf of beneficiaries.
Copayment
A fixed fee paid by the patient at the time of an office visit.
Capitation
Payment to a provider that covers each plan memeber's health care services for a certain period of time.
Fee-for-service
Health plan that repays the policyholder for covered medical expenses.
Accounts Receivable
Monies that are flowing into a business.
ICD-9 code
Identifies the diagnoses code
Premium
payment or reward (especially from a government) for acts such as catching criminals or killing predatory animals or enlisting in the military
Managed Care
A system that combines the financing and the delivery of appropriate, cost-effective health care services to its members.
Explanation of Benefits
A recap sheet that accompanies an insurance checks showing the breakdown and explanation of payments on a claim.
Audit/edit Report
a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer
Preferred Provider Organization
A managed care organization structured as a network of health care providers who agree to perform services for plan members at discounted fees; usually, plan members can receive services from non-network providers for a higher charge.
Patient Information Form
Form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim.
National Provider Identifcation Number
10 digit number that every insurance company has.