34 terms

MOSS Unit 2 Key Terms

STUDY
PLAY

Terms in this set (...)

Adjustment
Amounts that are taken away from (or added to) the balance of an account.
Ancillary
Additional office locations that are part of the same practice or one business entity.
Appointment scheduling system
A system that handles most of the tasks associated with patient visits to the office.
Business associate agreement
Allows covered entities to share PHI with business associates by assuring that the information will be appropriately safeguarded.
Clearinghouse
A service that helps the movement of electronic claims from the medical office to the insurance companies.
Co-insurance
The percentage of cost the primary insurance company will not pay.
Co-payment
A fixed payment at each office visit for which the patient is responsible.
Covered entities
Users protected under the HIPAA privacy rules.
CPT-4
The various codes that identify procedures performed for patients (Current Prodecural Terminology). Maintained in the file maintenance area.
Deductible
An out-of-pocket expense the patient must pay before the insurance company will pay for covered services.
Demographic information
Includes the patient's address, phone number, date of birth (DOB), gender, marital status, employer or school, etc.
Dunning message
A short collections note that appears on the bill.
Exclusions
Services not covered by a health insurance plan.
Fee schedule
A list of the charges established or agreed to by a medical professional for specific services.
File maintenance system
Utility area of the program that contains common information used by various systems within the software.
Guarantor
The person responsible for paying medical expenses; often included on the registration form.
Health Insurance Portability and Accountability Act (HIPAA)
A bill that provides guidelines for the protection of patient health information.
ICD-9
Maintained in the file maintenance (International Classification of Diseases).
Inpatient
When the patient will be staying at the hospital more than 24 hours.
Insurance billing system
Designed to prepare claims that are sent to insurance companies in order to receive payment for services rendered by medical providers.
Managed care
A system of health plans that attempts to control costs by limiting access to health care and focusing on preventative medicine.
Participating physician
Agrees to provide medical services to specific patient populations and negotiates for reimbursement under a contract.
Patient billing system
Uses claims sent to insurance companies, along with payments received and posted, to generate statements.
Patient registration system
Allows user to input information about each patient in the practice.
Posting payments system
Applies the payment to the patient's account.
Primary
First.
Procedure posting system
Fees for services are applied and other other information relevant to the encounter between patient to physician.
Protected Health Information (PHI)
Privacy rules apply to health information that can be individually identified in any form: orally, on paper, or electronically.
Reference sheet
Shows all patients scheduled on a given day.
Registration form
Also called a patient information data sheet; filled out by the person, or guardian of the person, to be treated by the physician.
Report generation system
Retrieves and organizes the data from various parts of the practice management software program into useful information, or reports.
Source documents
Documentation used as reference by the medical office staff.
Statement
A bill each month from the practice if there is a balance due.
Superbill
Charge slip, visit/fee slip.