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MOD 170 Unit 4
studies that an insurance company uses.
an item covered by an insurance policy, or something paid to or on the behalf of recipient
monetary compensation for physical impairment,pain and suffering, loss of earnings, or additional medical expenses as a result of the negligence.
buying insurance or coverage for the purpose of making a profit.
an insurance that would reimburse the employer when losses exceed a specific amount
insurance that covers plans when their benefit payments exceed a certain amount
any amounts paid toward the deductible by any member of the family will be added up to reach any deductible
person entitled to benefits or proceeds of an insurance policy or will
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
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
like or similar charges
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.
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.
allowable amount for that particular procedure assigned according to the particular CPT code
preapproval for admission on elective, nonemergency hospitalization
an estimate of maximum benefits that may be paid under the plan for the service
surgery recommended as an elective procedure when an alternative method of treatment may be preferable
determines whether the estimated length of time & scope of the inpatient stay is justified by the diagnosis & Symptoms.
files which are kept in batches or groups based on the date they were processed and the person who processed them
files for holding claims and other processing information
full credit adjustment
an adjustment that completely reverses a claim payment
states that the plan covering the male employee is primary, and the plan covering the female employee is secondary
COB applied to both medical and dental charges combined
partial credit adjustment
an adjustment that partially reverses a claim payment
surgical puncture to remove fluid from the cul-de-sac
hernia in which the urinary bladder protrudes through the wall of the vagina
D & C
dilation & curettage
the presence of endometrium elsewhere than in the lining of the uterus
of or relating to the external sex organs
surgical incision into the uterus (as in cesarean section)
intrauterine device; contraceptive
surgical removal of one of both ovaries
a political theory favoring the abolition of governments
to insemenate with pre sperm
absence of sperm in the semen
inflammation of the head of the penis
benign prostatic hyperplasia/hypertrophy
a man who has been castrated and is incapable of reproduction
surgical removal of one or both testicles
an abnormal tightness of the foreskin preventing retraction over the glans
inflammation of the prostate
a protein manufactured exclusively by the prostate gland
spermatozoa, sperm cells
a contraceptive agent that kills spermatozoa
transurethral resection of the prostate
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