Terms : Hide Images
| 1619032040 | Assignments of benefits | Reimbursement is directly sent from the payer to the provider | 0 | |
| 1619032041 | Accept assignment | The provider agrees to accept what the insurance company approves as payment in full for the claim | 1 | |
| 1619032042 | New patient | Us one who has not received professional service from the physician or other physician of the same specialty in the same group within the past three years | 2 | |
| 1619032043 | Established patient | One who received professional service from the physician or another physician of the same specialty in the same group within the past three years | 3 | |
| 1619032044 | Inpatient | Term used when a patient is admitted to the hospital with the expectations that the patient will stay for a period of 24 hours or more | 4 | |
| 1619032045 | Outpatient | Patient who receives treatment in any of the following seethings • physicians office • hospital clinic, emergency department, hospital same-day surgery unit, ambulatory surgical center ( patient is released within 23 hours ) • hospital admission for observation | 5 | |
| 1619032046 | Consultation | Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patients illness or suspected problem | 6 | |
| 1619032047 | Fee-for-service | A charged for each procedure or service performed by the physician. This is obtained from a *** schedule, which is a list of charges or allowance that have accepted for specific medical services. | 7 | |
| 1619032048 | Fiscal intermediary | Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area | 8 | |
| 1619032049 | Explanation of benefits (EOB) | Describes the services billed and includes a breakdown of how the payment is determines | 9 | |
| 1619032050 | Premium | Cost of insurance coverage paid annually, semi-annually or monthly to keep a policy in effect | 10 | |
| 1619032051 | Deductible | Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company | 11 | |
| 1619032052 | Co-payment | Cost sharing requirement for the insured to pay at the time of service. This is usually a specific dollar amount | 12 | |
| 1619032053 | Coinsurance | A percentage of the cost of covered services that a policyholder or a secondary insurance pays. (Common payment 80/20, which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is responsible | 13 | |
| 1619032054 | Coding | Process of converting diagnosis, procedures, and services into numeric and alphanumeric characters | 14 | |
| 1619032055 | Medical necessity | Defined by Medicare as "the determination that a service or procedure renders is reasonable and necessary for the diagnosis or treatment of an illness or injury" | 15 | |
| 1619032056 | Exclusion and limitations | Conditions, situations, and services not covered by the insurance carrier | 16 | |
| 1619032057 | Pre-certification | To determine coverage for a specific treatment such as surgery, hospitalization or test, under the insured's policy | 17 | |
| 1619032058 | Pre-determination | Determine the patients benefits and the maximum dollar amount that the insurance company will pay. First step, verification is completed prior to first visit | 18 | |
| 1619032059 | Pre-authorization | Requirement for some health plan to obtain permission for a service or procedure before it is done. Indicates that a specific procedure or service is deemed "medically necessary" | 19 | |
| 1619032060 | Qualified diagnosis | A working diagnosis which is not yet established | 20 | |
| 1619032061 | Eligibility | Qualifying factor or factors that must be met before a patient receives benefits | 21 | |
| 1619032062 | Coordination of benefits (COB) | When two insurance companies work together to coordinate payment of benefits | 22 | |
| 1619032063 | Encounter form | Is also called a superb ill. It's a listing of diagnosis, procedures, and charges for a patient's visit | 23 | |
| 1619032064 | Itemized statement | A statement of the patients account history, showing dates of service, detailed charges, payments ( i.e. deductibles and co-pays) the date the insurance claim was submitted, applicable adjustment and account balance | 24 | |
| 1619032065 | Peer review organization (PRO) | A state group of physicians working under government guidelines to review cases and determine their appropriateness and quality of professional care | 25 | |
| 1619032066 | Health insurance portability and accountability act (HIPAA) | Deals with prevention of healthcare fraud and abuse of patients on Medicare and Medicaid | 26 | |
| 1619032067 | Civil monetary penalties law (CMPL) | Law passed by the federal government to prosecute cases of Medicaid fraud | 27 | |
| 1619032068 | The Good Samaritan act | Developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care | 28 | |
| 1619032069 | Remittance advice | Is an electronic or paper-based report of payments sent by the payer to the provider | 29 | |
| 1619032070 | The patient care partnership (Patients Bill of Rights) | Was developed to promote the interest and well being of the patients and residents of the healthcare facility. This bill has still not become law | 30 |
