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50 terms

MOD 170 Unit 4

Medical Terminology
STUDY
PLAY
Actuarial statistics
studies that an insurance company uses.
benefit
an item covered by an insurance policy, or something paid to or on the behalf of recipient
compensatory
monetary compensation for physical impairment,pain and suffering, loss of earnings, or additional medical expenses as a result of the negligence.
insurance speculation
buying insurance or coverage for the purpose of making a profit.
reinsurance
an insurance that would reimburse the employer when losses exceed a specific amount
stoploss insurance
insurance that covers plans when their benefit payments exceed a certain amount
aggregate
any amounts paid toward the deductible by any member of the family will be added up to reach any deductible
beneficiary
person entitled to benefits or proceeds of an insurance policy or will
carryover deductible
any amounts which the patient pays toward their deductible in the last three months of the year will carry overy and will be applied to the next year's deductible
coinsurance limit
stipulates that if the coinsurance portion of a patient's bills reaches a certain amount, all subsequent claims will be paid at 100% of the allowed amount
credible coverage
like or similar charges
subrogation
the right for a portion of the recovery that the claimant may obtain from a third party
common accident provision
States that only one deductible, under Major medical, will be taken for all members of family involved in the same accident.
conversion factor
Dollar value of each unit. Each 3rd party payer issues a list of conversion factors which varies from one region to another. This is multiplied by the number of units in the procedure.
fee schedule
allowable amount for that particular procedure assigned according to the particular CPT code
precertification
preapproval for admission on elective, nonemergency hospitalization
predetermination
an estimate of maximum benefits that may be paid under the plan for the service
unnecessary surgery
surgery recommended as an elective procedure when an alternative method of treatment may be preferable
concurrent review
determines whether the estimated length of time & scope of the inpatient stay is justified by the diagnosis & Symptoms.
batch files
files which are kept in batches or groups based on the date they were processed and the person who processed them
claim files
files for holding claims and other processing information
full credit adjustment
an adjustment that completely reverses a claim payment
gender rule
states that the plan covering the male employee is primary, and the plan covering the female employee is secondary
global COB
COB applied to both medical and dental charges combined
partial credit adjustment
an adjustment that partially reverses a claim payment
colp/o
vagina.
culdocentesis
surgical puncture to remove fluid from the cul-de-sac
cystocele
hernia in which the urinary bladder protrudes through the wall of the vagina
D & C
dilation & curettage
endometriosis
the presence of endometrium elsewhere than in the lining of the uterus
genital
of or relating to the external sex organs
gynec/o
woman, female
hyster/o
uterus, womb
hysterotomy
surgical incision into the uterus (as in cesarean section)
IUD
intrauterine device; contraceptive
oophorectomy
surgical removal of one of both ovaries
anarchism
a political theory favoring the abolition of governments
artificial insemenation
to insemenate with pre sperm
azoospermia
absence of sperm in the semen
balanitis
inflammation of the head of the penis
BPH
benign prostatic hyperplasia/hypertrophy
castrate
a man who has been castrated and is incapable of reproduction
orchid
testes
orchidectomy
surgical removal of one or both testicles
phimosis
an abnormal tightness of the foreskin preventing retraction over the glans
prostatis
inflammation of the prostate
PSA
a protein manufactured exclusively by the prostate gland
spermat/o
spermatozoa, sperm cells
spermicide
a contraceptive agent that kills spermatozoa
TURP
transurethral resection of the prostate