Definitions for Final Exam
Terms : Hide Images
| 3057390514 | Accounts Receivable | monies owed to dr for services rendered | 0 | |
| 3057390515 | certification | a professional status or level earned by successful completion of an exam; a person who is cerified may subsequently list the designated credentials after their name | 1 | |
| 3057390516 | CEU | continuing education units; a level of measurement of noncredited education | 2 | |
| 3057390517 | outsourse | send work offsite | 3 | |
| 3057390518 | physician-based | pertaining only to physician | 4 | |
| 3057390519 | allowed amount | the dollar amount an insurance company deems fair for a specific service or proceure | 5 | |
| 3057390520 | beneficiary | term used for a pt who has medicare coverage | 6 | |
| 3057390521 | capitated | system in which a dr is prepaid monthly for members enrolled in a hmo with which the dr has contracted. The payment is made to the dr regardless of whether he sees pts or not in this plan | 7 | |
| 3057390522 | CMS | centers for medicare & medicaid services; a government agency that oversees the medicare and medicaid programs | 8 | |
| 3057390523 | co-insurance | a percentage the pt is responsible to pay of the cost of medical services; this is associated with indemnity, traditional and commercial health insurance plans | 9 | |
| 3057390524 | commercial | another term for indemity or traditional health insurance plans | 10 | |
| 3057390525 | co-payment | a flat fee the pt pays each time for medical services; this is associated with managed care plans | 11 | |
| 3057390526 | coverage | existence and scope of exising health insurance | 12 | |
| 3057390527 | deductible | the amount the pt is responsibleto pay before any reimbursement is issued by the insurance company, this is usually associated with indemnity, traditional and commercial plans | 13 | |
| 3057390528 | dependents | persons covered under the policyholders plan | 14 | |
| 3057390529 | disability insurance | insurance providing income to a policyholder who is disabled and cannot work | 15 | |
| 3057390530 | fee for service | a payment system in which the dr is paid a specific amount for each service performed | 16 | |
| 3057390531 | fee schedule | a list of allowed amounts for all services and procedures payable by the insurance company | 17 | |
| 3057390532 | fiscal agent | a company that contracts with CMS to pay medicaid claims | 18 | |
| 3057390533 | government plan | a health insurance plan funded by the government | 19 | |
| 3057390534 | group number | the number on the ID card that identifies the pts employer group health plan | 20 | |
| 3057390535 | HMO | health maintenance organization; a prepaid medical service plan that provides services to plan members | 21 | |
| 3057390536 | indemnity plan | a type of insurance plan in which reimbursement is made at 80% of allowed amount. The pts is then responsible to pay remaining 20%. | 22 | |
| 3057390537 | indigent | impoverished; needy; poor | 23 | |
| 3057390538 | in network | medical care sought from participating providers within a managed care plan | 24 | |
| 3057390539 | insured | another term for policyholder or subscriber | 25 | |
| 3057390540 | managed care plan | a health insurance plan that includes financing, management & delivery of health care services | 26 | |
| 3057390541 | medicaid | a government plan for financially indigent people | 27 | |
| 3057390542 | medicare | a government health insurance plan primarily covering persons aged 65 and older (or disabled) | 28 | |
| 3057390543 | medigap | supplemental insurance for pts with medicare as primary; these plans may pick up the medicare deductible & co-insurance | 29 | |
| 3057390544 | MTF | military treatment facility; a place where tricare members receive medical treatment | 30 | |
| 3057390545 | out of network | the pts share of the cost of health care services; this can include co-pay, co-insurance or deductible | 31 | |
| 3057390546 | outpatient | services performed at a facility where the pt stays less than 24 hrs and is not admitted to the facility; also the term is used for the pt receiving such services | 32 | |
| 3057390547 | POS plan | point of service plan; a health insurance plan in which the pt pays a co-pay when staying in network | 33 | |
| 3057390548 | PPN | preferred provider network; a group of civilian medical providers that has contracted with tricare | 34 | |
| 3057390549 | PPO | preferred provider organization; this type of plan offers discounts to insurance company clients in exchange for more members | 35 | |
| 3057390550 | PCP | primary care physcian; a dr (or other health care provider) who is responsible for a pts main health care | 36 | |
| 3057390551 | referral | permission from the PCP to seek services from a specialists for an evaluation, testing and /or treatment; managed care plans require this | 37 | |
| 3057390552 | secondary | the insurance plan that is billed after the primary has paid or denied payment | 38 | |
| 3057390553 | self-pay | a patient with no health insurance - who must pay out of pocket for medical care | 39 | |
| 3057390554 | tricare extra | a tricare plan available only to retired military service members and their families; this plan is NOT available over seas | 40 | |
| 3057390555 | tricare standard | tricare plan available only to retired military service members and their families; this plan IS available both in US and overseas | 41 | |
| 3057390556 | tricare prime | tricare plan offering coverage for active duty service members; retired members may also select this plan | 42 | |
| 3057390557 | codes | assigned letters, numbers or a combination of both used to report procedures, services, supplies, durable medical equipment & diagnoses | 43 | |
| 3057390558 | CPT | codes used to report services and procedures; these are LVL I codes under HCPCS | 44 | |
| 3057390559 | CPT Modifiers | a 2 character numeric descriptor used only with CPT codes | 45 | |
| 3057390560 | diagnosis | the conclusion reached abotu a patients ailment by thorough review of the pts history, exam and review of lab data | 46 | |
| 3057390561 | E Codes | codes used to describe external causes of injury, poinsoning or other adverse rections affecting the pts health | 47 | |
| 3057390562 | HCPCS | a coding system used to report procedures, services, supplies, medicine & durable medical equipment; comprised of CPT (LVL I) & national (LVL II) codes | 48 | |
| 3057390563 | ICD-9-CM | international classification of diseases, 9th revision, clinical modification; the ICD-9 codes are used to report diagnoses, signs & symptoms of pt | 49 | |
| 3057390564 | modifier | a 2 character alphabetic, numeric, or alphanumeric descriptor used to signify that a procedure or service has been altered by an unusual or specific circumstance, although the code itself has not changed; additional use includes referencing a specific body site | 50 | |
| 3057390565 | V codes | ICD-9 codes assigned for preventive medicine services & for reasons other than disease or injuries | 51 | |
| 3057390566 | authorization | pts signed approval | 52 | |
| 3057390567 | consult | term used when a dr calls upon antoher dr to evalulate & make assessment on a pt in the hospital setting (99241-99245) | 53 | |
| 3057390568 | demographics | statistical information on pt (boxes 1-13) | 54 | |
| 3057390569 | encounter form | another name for superbill | 55 | |
| 3057390570 | established pt | a pt who has been seen in past 36 mos (99211-99215) | 56 | |
| 3057390571 | new pt | a pt who has never been seen or who has not been seen in past 36 mos (99201-99205) | 57 | |
| 3057390572 | follow up visit | subsequent visit made by the dr following an admission (99231-99233) | 58 | |
| 3057390573 | HCPCS Modifier | a 2 character alphabetic or alphanumeric descriptor used with both CPT LVL I national LVL II codes | 59 | |
| 3057390574 | HIPAA | health insurance portability and accountability act of 1996; a law that stipulates pts privacy rights regarding their PHI | 60 | |
| 3057390575 | home visit | a visit made by the dr to the pts home | 61 | |
| 3057390576 | medical chart | a confidential document that contains detailed and comprehensive information on the individual pt and the care given to that pt | 62 | |
| 3057390577 | nursing home visit | a visit made by the dr to a pt who resides in a nursing home | 63 | |
| 3057390578 | pt registration form | a form used to gather all pts information, including demogaphics & insurance info | 64 | |
| 3057390579 | PHI | protected health information | 65 | |
| 3057390580 | superbill | a form listing CPT, HCPCS & ICD-9 codes used to record services performed for the pt and the pts dx for a given visit | 66 | |
| 3057390581 | legacy number | an identification number assigned to a dr tha identifies the dr to payers | 67 | |
| 3057390582 | NPI | national provider identifier; a 10-digit intelligence free numeric identifier | 68 | |
| 3057390583 | payer | synonym for insurance company | 69 | |
| 3057390584 | referred | pt is sent to a specialist for evulation & testing | 70 | |
| 3057390585 | specialist | dr who concentrates on a particular are of medicine (oncologist/cardiologist) | 71 | |
| 3057390586 | inpatient | a pt who has been admitted to hospital (99251-99255) | 72 | |
| 3057390587 | intermediate care facility | an institution that provides health related care and services to individuals who do not require the degree of care and treatment that a hospital or nursing facility is designed to provide | 73 | |
| 3057390588 | long term care facility | a facility that provides medical services and assistance to pts over an extended period of time and is designed to meet the medical, personal and social needs of the pt | 74 | |
| 3057390589 | nursing facility | a facility tha tprovides continuous medical supervision via 24-hr-a-day nursing care and related services, in addition to food, shelter and personal care | 75 | |
| 3057390590 | batch | set of claims | 76 | |
| 3057390591 | claim attachment | additional information submitted with the health insurance claim (progress notes etc) | 77 | |
| 3057390592 | clean claim | claim with no errors | 78 | |
| 3057390593 | clearinghouse | entity that forwards claims to insurance payers electronically (cks for erros prior to sending, rejects if any found; refusal to accept) | 79 | |
| 3057390594 | EDI | electronic data interchange; a mutual exchange of data via computer modem | 80 | |
| 3057390595 | encrypted | information that is converted into code for security purposes | 81 | |
| 3057390596 | EFT | electronic funds transfer;payment method in which funds are deposited directly into dr back acct | 82 | |
| 3057390597 | EOB | explanation of benefits; the form sent to dr and/or pt detailing benefits paid or denied by insurance company | 83 | |
| 3057390598 | insurance adjustment | write off ; the dollar amount adjusted off pts account reflecting the difference between fee for services billed and the allowed amount determined by insurance company | 84 | |
| 3057390599 | posting | act of making an entry in the pts account | 85 | |
| 3057390600 | appeal | procedure used when payer denies a service that the pt thinks is needed or refuses to pay for care that the pt has already received | 86 | |
| 3057390601 | denied | refused to grant (as in payment for claim) | 87 | |
| 3057390602 | noncovered | service or procedure not listed as a covered benefit in the payers master benefit list | 88 | |
| 3057390603 | rejected | refused to accept (clearinghouse) | 89 | |
| 3057390604 | unauthorized | authorization or approval not obtained prior to treatment | 90 | |
| 3057390605 | pt aging report | report showing money owed to dr form pt (pt balances due) | 91 | |
| 3057390606 | overhead | business expense | 92 | |
| 3057390607 | insurance aging report | report showing money owed to dr from insurance company | 93 | |
| 3057390608 | cashflow | stream of cash (income)used for disbursement | 94 | |
| 3057390609 | age | grow old | 95 | |
| 3057390610 | critical care | direct delivery by a dr of medical care for a critically ill or injured pt | 96 | |
| 3057390611 | initial hospital care | the first hospital in pt encounter with a pt by the admitting dr | 97 | |
| 3057390612 | subsequent hospital care | care provided to pt (per day) following the initial hospital care (follow up) | 98 |
