Medical Office Billing Process Flashcards

Chapter #1 Key terms in PPC's Medical Office Software with Connie(Nights).Book's titled,"Computers in the Medical Office 6th edition".

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3480865296	Accounting Cycle	Flow of financial transactions in a business.	0
3480865297	Accounts Receivable(AR)	Monies that are flowing IN to a business.	1
3480865298	Adjudication	Series of steps that determine whether a claim should be paid.	2
3480865299	Billing Cycle	Regular schedule of sending statements to patients.	3
3480865300	Capitation	Advance payment to a provider that covers each plan member's health care services for a certain period of time.	4
3480865301	Coding	Process of assigning standarized codes to diagnoses and procedures.	5
3480865302	Coinsurance	Part of charges that an insured person must pay for health care services after payment of the deductible amount.	6
3480865303	Consumer-driven health plan(CDHP)	A type of managed care in which a high-deductible/low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible amount.	7
3480865304	Copayment	A small fixed fee paid by the Pt at time of office visit.	8
3480865305	Diagnosis	Physician's opinion of nature of Pt's illness or injury.	9
3480865306	Diagnosis Code	Standarized value that represents a Pt's illness, signs, symptoms.	10
3480865307	Encounter Form	List of procedures and charges for a Pt's visit.	11
3480865308	Explanation of Benefits(EOB)	Paper document from a payer that shows how amount of a benefit was determined.	12
3480865309	Fee-for-service	Health plan that repays policyholder for covered medical expenses.	13
3480865310	Health Maintenance Organization(HMO)	Managed health casre system in which providers agree to offer health care to the organization's members for fixed periodic payments from the plan.	14
3480865311	Health Plan	Plan, program, or organization that provides health benefits.	15
3480865312	Managed Care	Type of insurance in which carrier is responsible for both the financing and delivry of health care.	16
3480865313	Medical Coder	Person who analyzes and codes Pt diagnoses, procedures, and symptoms.	17
3480865314	Medical Necessity	Tx provided by a physician to a Pt for purpose of preventing, diagnising, or treating an illness, injury, or its symptoms in a manner that's appropriate and provided in accordance w/ generally accepted standards of med. prac.	18
3480865315	Modifier	A two-digit character that's appended to a CPT code to report special circumstances involved w/a procedure or service.	19
3480865316	Patient Information Form	Form that includes a Pt's personal, employment, and insurance data needed to complete an insurance claim.	20
3480865317	Payer	Private or government org that insures or pays for health care on behalf of beneficiaries.	21
3480865318	Policyholder	Person who buys an insurance plan; the insured.	22
3480865319	Practice Management Program(PMP)	Software program that automates many of the administrative and financial tasks required to run a medical practice.	23
3480865320	Preferred Provider Organization(PPO)	Managed care network of health care providers who agree to preform services for plan members at discounted fees.	24
3480865321	Premium	Periodic amount of money the insured pays to a health plan for insurance coverage.	25
3480865322	Procedure	Medical treatment provided by a physician or other health care provider.	26
3480865323	Procedure Code	Code that identifies a medical service.	27
3480865324	Remittance Advice(RA)	An explanation of benefits transmitted electronically by a payer to a provider.	28
3480865325	Statement	A list of all services preformed for a Pt, along w/ charges for each service.	29
3480865326	Steps of Billing Process	1.Preregister Pt 2.Establish financial responsibilty 3.Check in Pt 4.Check out Pt 5.Review Coding compliance 6.Check billing compliance 7.Prepare and transmit claims 8.Moniter payer adjudication 9.Generate Pt statements 10. Follow up payments and collections	30