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Study sets matching "terms medical insurance"

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Study sets matching "terms medical insurance"

73 terms
Medical Insurance terms
Accident Insurance
Accidental Death Benefit
Admission
Adult Wellness
A type of insurance enabling the policy holder to get a certa…
A benefit on a life insurance policy that equals the value of…
An inpatient or overnight entry into a hospital, skilled nurs…
Covered services for routine health care screenings and check…
Accident Insurance
A type of insurance enabling the policy holder to get a certa…
Accidental Death Benefit
A benefit on a life insurance policy that equals the value of…
25 terms
Medical Insurance Terms
Authorization
Business Associate
Clearinghouse
Notice Of Privacy Practices
1) Document signed by a patient to permit release of medical…
Person or organization that performs a function or activity f…
Company that converts nonstandard transactions and transmits…
Description of a covered entity's principles and procedures r…
Authorization
1) Document signed by a patient to permit release of medical…
Business Associate
Person or organization that performs a function or activity f…
36 terms
Medical/Insurance terms and abbreviations
Abuse
Civilian Health and Medical Program of…
Clinical Laboratory Improvement Act (C…
Consolidated Omnibus Budget Reconcilia…
Using something to bad effect or for a bad purpose; misuse.
A federal health benefits program for family members of total…
This act, regulations include federal standards applicable to…
Provides contrary coverage of group health benefits to employ…
Abuse
Using something to bad effect or for a bad purpose; misuse.
Civilian Health and Medical Program of…
A federal health benefits program for family members of total…
13 terms
Medical Insurance Terms
provider
guarantor
Carrier
benefits
another name for the physician.
responsible for the account. An individual who promises to pa…
Another name for insurance company or health plan.
payments made by the insurance company
provider
another name for the physician.
guarantor
responsible for the account. An individual who promises to pa…
361 terms
Medical Insurance and Coder Terms
Coding is
Proper code assignment is determined by
what are 3 things that Coder must master
Medical coders assign a code to what
the process of translating this written or dictated fmedical…
content of the medical record and by the unique rules that go…
1. anatomy... 2. medical terminology... 3. must be detail-oriented
1. Each diagnosis... 2. service/procedure... 3. Supply, using the c…
Coding is
the process of translating this written or dictated fmedical…
Proper code assignment is determined by
content of the medical record and by the unique rules that go…
160 terms
Medical Insurance Terms
Overpayment
Prevailing charges
Peer Review Organization
Format Rejection
Money paid over and above the amount due by the insurer or pa…
The most frequently charged fees in an area by a specialty gr…
a group of physicians and specialists... contracted by the Cente…
Immediate feedback that the file has details missing or incor…
Overpayment
Money paid over and above the amount due by the insurer or pa…
Prevailing charges
The most frequently charged fees in an area by a specialty gr…
19 terms
Medical Insurance
assignment of benefits
beneficiary
benefit
birthday rule
authorization given by the patient to allow the insurance com…
person who can receive benefits under an insurance plan
payment for a covered service under a health insurance plan
insurance plan of parent whose birthday comes earlier in the…
assignment of benefits
authorization given by the patient to allow the insurance com…
beneficiary
person who can receive benefits under an insurance plan
12 terms
Medical Insurance Terms
provider
guarantor
Carrier
benefits
Another name for the physican
responsible for the account. An individual who promises to pa…
Another name for insurance company or health plan.
payments made by the insurance company
provider
Another name for the physican
guarantor
responsible for the account. An individual who promises to pa…
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
61 terms
Medical Insurance
Point of Service (POS)
Coinsurance
Mental Health Expenses
National Correcting Coding Initiative…
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Claims submitted for psychiatric services.
Developed to control improper coding.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
99 terms
Medical Insurance Terms
accidental death and dismemberment rid…
annual out-of-pocket maximum
applicant
beneficiary
A supplement too many life insurance policies that provide an…
A dollar amount set by the plan which puts a cap on the amoun…
The person or business that applies for an insurance policy i…
The owner, person or party, of a life insurance policy names…
accidental death and dismemberment rid…
A supplement too many life insurance policies that provide an…
annual out-of-pocket maximum
A dollar amount set by the plan which puts a cap on the amoun…
10 terms
Medical & Insurance Terms
HIPAA
HCFA
ICD-10-CM
CPT
Health Insurance Portability & Accountability Act(1996)... -was…
Health care financing administration
International classification of diseases 10th revision clinic…
Current Procedural terminology
HIPAA
Health Insurance Portability & Accountability Act(1996)... -was…
HCFA
Health care financing administration
11 terms
Medical Insurance Key Terms
abstracting
claims attachment
coding
ICD-9-CM
collecting information from a medical record
medical report attached to the claim form substantiating a me…
assignment of a code to the patient's diagnoses, procedures f…
International Center of Disease, 9th Revision, Clinical Modif…
abstracting
collecting information from a medical record
claims attachment
medical report attached to the claim form substantiating a me…
11 terms
Medical insurance terms
Abstracting
Claims attachment
Coding
ICD-9-CM
Collecting information from a medical record
Medical report attached to the claim form substaining a medic…
Assignment of a code to the patients diagnoses procedures for…
International classification of diseases, 9th revision, clini…
Abstracting
Collecting information from a medical record
Claims attachment
Medical report attached to the claim form substaining a medic…
23 terms
Medical Insurance terms
Birthday Rule
Pre- Authorization
Fee- For- Service
HMO
The Birthday Rule Is to Determine Which Policy covers the dep…
Insurance Plan's approval for a health care provider to provi…
Insurance plan that Pays a physician a fee for every patient…
Health maintenance Organization
Birthday Rule
The Birthday Rule Is to Determine Which Policy covers the dep…
Pre- Authorization
Insurance Plan's approval for a health care provider to provi…
21 terms
Medical Insurance Terms
Assignment of benefits
Balance Billing
Birthday rule
Capitation
Transfer of patients legal right to collect 3rd party benefits
Difference patient is billed
Determination which policy pays when patient has two policy's
Managed care plan that pays certain amount to a provider over…
Assignment of benefits
Transfer of patients legal right to collect 3rd party benefits
Balance Billing
Difference patient is billed
10 terms
Medical Insurance Terms
Pre-Existing Condition
Referral
Co-Payment
Co-Insurance
A medical condition that existed in the patient before he/she…
When a physician requests that his patient see another doctor…
A specific amount of money a patient pays for a particular se…
Requires that specific percentages of expenses are shared by…
Pre-Existing Condition
A medical condition that existed in the patient before he/she…
Referral
When a physician requests that his patient see another doctor…
11 terms
Medical Insurance Key Terms
adstracting
claims attachment
coding
ICD-9-CM
collecting information from a medical record
medical report attached to the claim form substantiating a me…
assignment of a code to the patient's diagnoses, procedures f…
International Classification of Diseases, 9th Revision, Clini…
adstracting
collecting information from a medical record
claims attachment
medical report attached to the claim form substantiating a me…
15 terms
Medical Insurance Terms
Categorically Needy
Children's Health Insurance Program
Crossover Claim
Dual Eligible
A person who receives assistance from government program such…
Program offering health insurance coverage for uninsured chil…
Claim for a Medicare or Medicaid beneficiary; Medicare is the…
A Medicare-Medicaid beneficiary
Categorically Needy
A person who receives assistance from government program such…
Children's Health Insurance Program
Program offering health insurance coverage for uninsured chil…
Medical insurance key terms
Abstracting
Claims attachment
Coding
ICD-9-CM
Collecting info from a medical record
Medical report attached to the claim form substaniating a med…
Assignment of a code to the patients diagnoses, procedures fo…
International classification of diseases 9th revision clinica…
Abstracting
Collecting info from a medical record
Claims attachment
Medical report attached to the claim form substaniating a med…
18 terms
Medical/Insurance Terms
Abuse
Civilian Health and Medical Program of…
Clinical Laboratory Improvement Act (C…
Consolidated Omnibus Budget Reconcilia…
Incidents or practices by a medical staff that is not usually…
A program that provides health benefits for dependent D of ve…
Congress passed in 1988, to establish quality standards for a…
Allow employments to contribute health care coverage beyond t…
Abuse
Incidents or practices by a medical staff that is not usually…
Civilian Health and Medical Program of…
A program that provides health benefits for dependent D of ve…
27 terms
Medical/Insurance terms and abbreviations
Abuse
Civilian Health and Medical Program of…
Clinical Laboratory Improvement Act (C…
Consolidated Omnibus Budget Reconcilia…
Using something to bad effect or for a bad purpose; misuse.
A federal health benefits program for family members of total…
This act, regulations include federal standards applicable to…
Provides contrary coverage of group health benefits to employ…
Abuse
Using something to bad effect or for a bad purpose; misuse.
Civilian Health and Medical Program of…
A federal health benefits program for family members of total…
30 terms
Medical Insurance Key terms
Customary fee
Allowed charge
Copayment
Schedule of benefits
The fee that is in the range of usual fees charged by physici…
The maximum charge that a health plan pays for a specific ser…
A small fixed fee paid by the patient at the time of an offic…
list of medical expenses covered by a health plan
Customary fee
The fee that is in the range of usual fees charged by physici…
Allowed charge
The maximum charge that a health plan pays for a specific ser…
39 terms
Medical insurance terms
Cost sharing
Hippa
Cobra
Cobra
A situation were insured individuals pay a portion of the hea…
Health Insurance Portability and Accountability Act
What does Consolidated Omnibus Budget Reconciliation Act stan…
A health benefit act that Congress passed in 1986 when an emp…
Cost sharing
A situation were insured individuals pay a portion of the hea…
Hippa
Health Insurance Portability and Accountability Act
31 terms
Medical Insurance Terms
adjudication
assignment of benefits (aob)
beneficiary
capitation
process determining payment/denial
an authorized signature of the patient for payment at the tim…
a person who receives health benefits
flat fee payment
adjudication
process determining payment/denial
assignment of benefits (aob)
an authorized signature of the patient for payment at the tim…
15 terms
Medical Insurance terms 2
Managed Care
Indiviual Policies
Government Sponsored Programs
Blue Cross/Blue Shield
Fixed, prepaid fee plans with contracted providers.
Purchased through commercial insurance companies.
Financed through federal and state governments.
Operates in all states, largest medical insurance system in t…
Managed Care
Fixed, prepaid fee plans with contracted providers.
Indiviual Policies
Purchased through commercial insurance companies.
15 terms
Glossary of medical insurance terms
Affordable care act
Allowed amount
annual limit
Benefit Period
The comprehensive health care reform law enacted in March 201…
The highest amount we will cover/pay for a service.
A cap on the benefits your insurance company will pay in a ye…
normally 1/1-12/31 oasis 10/1-9/30
Affordable care act
The comprehensive health care reform law enacted in March 201…
Allowed amount
The highest amount we will cover/pay for a service.
10 terms
Medical and Insurance Terms
HIPAA
HCFA
ICD-10-CM
CPT
Health Insurance Portability and Accountability Act (1996)
Health Care Financing Administration
International Classification of Disease 10th Revision Clinica…
Current Procedural Terminology
HIPAA
Health Insurance Portability and Accountability Act (1996)
HCFA
Health Care Financing Administration
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
44 terms
insurance medical term 2
Hernia
Thymus
Peritoneal
Endomyocardial
Organ or tissue protruding through the wall or cavity that us…
Gland that produces hormones important to the immune response
Within the lining of the abdominal cavity
Pertaining to the inner and middle layers of the heart
Hernia
Organ or tissue protruding through the wall or cavity that us…
Thymus
Gland that produces hormones important to the immune response
50 terms
insurance medical term 1
Cardioversion
Adenoidectomy
Thyroid
Adrenals
Electrical shock to the heart to restore normal rhythm
Removal of the adenoids
Part of the endocrine system that produces hormones that regu…
Glands, located at the top of the kidney, that produce steroi…
Cardioversion
Electrical shock to the heart to restore normal rhythm
Adenoidectomy
Removal of the adenoids
17 terms
Medical/Insurance terms and abbreviations
Breach of Confidentiality
Civil Law
Criminal Law
Confidentiality
Unauthorized release of patient information to a third party.
areas of law not classified as criminal
public law governed by statute or ordinance that deals with c…
ensuring that information is accessible only to those authori…
Breach of Confidentiality
Unauthorized release of patient information to a third party.
Civil Law
areas of law not classified as criminal
10 terms
Medical Insurance Terms
Pre-existing condition
Referral
Co-payment
Co-insurance
A medical condition that existed in the patient before he/she…
When a physician requests that his patient see another doctor…
A specific amount of money a patient pays for a particular se…
Requires that specific percentages of expenses are shared by…
Pre-existing condition
A medical condition that existed in the patient before he/she…
Referral
When a physician requests that his patient see another doctor…
30 terms
Medical Insurance Midterm terms
(EPO) Exclusive Provider Organization
(IDS) Integrated delivery System
(HMO) Health Maintenance Organization
(POS) Point-of-Service Plan
managed care plan that provides benefits to subscribers who a…
organization of affiliated providers' sites (e.g., hospitals,…
HMO act of 1973 (fee-for-service)... an alternative traditional…
patients have freedom to use managed care panel of providers…
(EPO) Exclusive Provider Organization
managed care plan that provides benefits to subscribers who a…
(IDS) Integrated delivery System
organization of affiliated providers' sites (e.g., hospitals,…
17 terms
Medical Insurance Terms 2
Acute
Alphabetic Index
Chief Complaint (CC)
Chronic
Description of an illness or condition having severe symptoms…
A part of ICD-10-CM that list diseases and injuries alphabeti…
A patients description of a symptom or other reasons for seek…
Description of an illness or condition with a long duration.
Acute
Description of an illness or condition having severe symptoms…
Alphabetic Index
A part of ICD-10-CM that list diseases and injuries alphabeti…
23 terms
Medical Insurance Coding Terms
Encounter
Diagnosis
Acute
Chronic
Every meeting between a patient and a healthcare provider. Th…
(Dx) determination of the nature of a disease based on signs,…
Ocurring now; of short term duration
Occuring over the long term or recurring frequently
Encounter
Every meeting between a patient and a healthcare provider. Th…
Diagnosis
(Dx) determination of the nature of a disease based on signs,…
19 terms
Medical/Insurance Terms and Abbreviations
Breach of Confidentiality
Civil Law
Criminal Law
Confidentiality
Inauthorized release of patient info to a third party
Area of law not classified as criminal
Public law governed by statute of ordinance that deals with c…
Ensuring that info is accessible only... To those authorized to…
Breach of Confidentiality
Inauthorized release of patient info to a third party
Civil Law
Area of law not classified as criminal
31 terms
Medical Insurance Billing Terms
ICD 9 CM Manual
ICDM 9 CM
CPT 4
CPT 4
This type of coding is used for diagnosis.
International classification of Diseases, 9th revision, Clini…
This type of coding is used for procedures.
Current procedural terminology 4th edition.
ICD 9 CM Manual
This type of coding is used for diagnosis.
ICDM 9 CM
International classification of Diseases, 9th revision, Clini…
9 terms
Insurance terms to know ( medical )
Refferal
Co-pay
Co-insurance
Deductable
When a physician request that his/her patient see andother do…
Specific amount of money a patient pays for a particular serv…
Requires that specific percentages of expenses are shared by…
Amount paid by the patient for medical services before the in…
Refferal
When a physician request that his/her patient see andother do…
Co-pay
Specific amount of money a patient pays for a particular serv…
64 terms
Medical insurance terms CMAA
Accounts payable
Accounts receivable
admitting physician
advanced directive
-total amount owed by the practice to suppliers and other ser…
-total amount of all charges for services rendered to patient…
-The physician who admits a patient to the hospital
-A printed and signed statement to direct those who will take…
Accounts payable
-total amount owed by the practice to suppliers and other ser…
Accounts receivable
-total amount of all charges for services rendered to patient…
11 terms
Medical/ insurance terms and abb
Health maintenance organization
Occupational safety and health adminis…
Major medical insurance
Primary care provider PCP a.k.a primar…
Responsible for providing health care services to subscribers…
Legislation designed to protect all employees against injurie…
Coverage for catastrophic or prolonged illnesses and /or inju…
Responsible for supervision and coordination of health care s…
Health maintenance organization
Responsible for providing health care services to subscribers…
Occupational safety and health adminis…
Legislation designed to protect all employees against injurie…
45 terms
Cardiology and Medical Insurance Terms
Asystole
Beneficiary
Angioplasty
Coinsurance
Complete absence of a heart beat
A person eligible to receive benefits
Surgical repair of a blood vessel
Percentage of the allowed amount that is the patient's respon…
Asystole
Complete absence of a heart beat
Beneficiary
A person eligible to receive benefits
42 terms
Medical insurance terms and abbreviations
Abuse
Civilian health and medical program of…
Champva
Clinical laboratory improvement act
Incidents of practices by a medical staff that is not usually…
A program that provides health benefits for dependents of vet…
Civilian health and medical program of the department of vete…
Congress passes in 1988to establish quality standards for all…
Abuse
Incidents of practices by a medical staff that is not usually…
Civilian health and medical program of…
A program that provides health benefits for dependents of vet…
83 terms
Medical Insurance Final
List the 10 steps of the Billing Cycle
Why is cash flow important in a medica…
Under an insurance contract who is the…
Under an insurance contract who is the…
1.Preregistration... 2. Establish Financial Responsibility... 3. Ch…
To pay for office expenses
The Patient
The Physician
List the 10 steps of the Billing Cycle
1.Preregistration... 2. Establish Financial Responsibility... 3. Ch…
Why is cash flow important in a medica…
To pay for office expenses
30 terms
Medical Insurance Chapter 14
What makes a good financial policy?
Some items a Financial policy should c…
Why is it a good idea to collect fees…
What does a day sheet in a medical off…
It is clear to both patients and practice staff
Collection of Co payments, deductibles, past due balances... Cha…
To avoid having to bill patients for unassigned claims
All the transactions that were posted to all patient ledgers…
What makes a good financial policy?
It is clear to both patients and practice staff
Some items a Financial policy should c…
Collection of Co payments, deductibles, past due balances... Cha…
15 terms
Medical, Auto and Insurance Terms
The root word "stomat" refers to:... 1 St…
The suffix "somatic" refers to:... 1 Brai…
A mutual insurance company is:... 1 Owned…
What is an insurance producer's "impli…
3 Mouth ... "Stomat" refers to the mouth.
2 Body ... The suffix somatic refers to the body.
1 Owned by its policyholders. ... Policyholders own a mutual co…
3 Authority given by the principal to the agent that is not f…
The root word "stomat" refers to:... 1 St…
3 Mouth ... "Stomat" refers to the mouth.
The suffix "somatic" refers to:... 1 Brai…
2 Body ... The suffix somatic refers to the body.
37 terms
Medical Insurance Chapter 6
Audit
Internal Audit
External Audit
Recovery Audit Contractor - RAC
methodical review
self audit conducted by a staff member or consultant
audit conducted by an outside organization
program designed to audit Medicare claims
Audit
methodical review
Internal Audit
self audit conducted by a staff member or consultant
34 terms
Medical Insurance Chapter 13
Determination
Who would establish the medical review…
Who verifies the medical necessity of…
The process of determining whether to…
Payer's decision about the benefits due for a claim
Third-Party Payer
Claims Examiner
Adjudication
Determination
Payer's decision about the benefits due for a claim
Who would establish the medical review…
Third-Party Payer
64 terms
Medical Insurance
Point of Service (POS)
Coinsurance
Mental Health Expenses
National Correcting Coding Initiative…
A plan that permits patients to receive medical services from…
An agreement between the member and the insurance carrier to…
Claims submitted for psychiatric services.
Developed to control improper coding.
Point of Service (POS)
A plan that permits patients to receive medical services from…
Coinsurance
An agreement between the member and the insurance carrier to…
21 terms
Medical insurance mid term #1
Hold harmless clause
Coding
What is medical necessity?
Who publishes the CPT manual?
policy that the patient is not responsible for paying what th…
process of reporting diagnoses, procedures, and services as n…
involves linking every procedure or service code reported on…
the American Medical Association
Hold harmless clause
policy that the patient is not responsible for paying what th…
Coding
process of reporting diagnoses, procedures, and services as n…
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