Final MO136 Flashcards

10749840378	Three parties of an insurance contract	1. Patient/ subscriber 2. Provider/ PCP 3. Payer/ insurance	0
10749840379	fee for service	Payment method based on provider charges	1
10749840380	Capitated rate	Prospective payment - fixed prepayment covering provider's services for a plan member for a specified period	2
10749840381	Out of pocket expenses	Expenses the insured must pay out of pocket prior to benefits	3
10749840382	Referral	Transfer of patient care from one physician to another	4
10749840383	Pre- authorization	Prior authorization from a payer for services to be provided	5
10749840384	Medicare	Over 65 years, people with specific disabilities	6
10749840385	Medicare Part A	Hospital coverage	7
10749840386	Medicare Part B	Outpatient care - medigap	8
10749840387	Medicare part C	HMO - combines coverage for part A and part B	9
10749840388	Medicare Part D	Prescription drug coverage	10
10749840389	Tricare	military insurance	11
10749840390	CHAMPVA	veterans insurance	12
10749840391	Medicaid	Low income people who cannot afford medical care	13
10749840392	EMR	Computerized records of one physicians encounters with a patient over time that are the physicians legal record of patient care	14
10749840393	EMR	electronic medical record	15
10749840394	Subpoena Duces Tecum	Court requires the witness to bring evidence	16
10749840395	CMS	Centers for Medicare and Medicaid Services	17
10749840396	HIPAA Security Rule	law requiring covered entities to establish physical and technical safeguards to protect health information	18
10749840397	HIPAA rules	Privacy, security, electronic code set standards	19
10749840398	HIPAA Privacy Rule	Law regulating the use and disclosure of patients protected health information as TPO and PHI	20
10749840399	Electronic code set standards	Require every provider who does business electronically to use the same healthcare transactions, code sets and identifiers	21
10749840400	PHI	Protected Health Information	22
10749840401	Three covered entities	1. Providers 2. Payers/ insurance 3. Business associates and billing clearinghouse	23
10749840402	NPI	National Provider Identifier	24
10749840403	NPI definition	Unique ten digit identified assigned to each provider	25
10749840404	CMS	Agency that runs Medicare, Medicaid, clinical laboratories, and other government health programs	26
10749840405	Assignment of benefits	Authorization allowing benefits to be paid directly to a provider	27
10749840406	Premium	Money the insured pays to a health plan for a policy	28
10749840407	Deductible	Amount insured must pay for healthcare services before a health plan's payment begins	29
10749840408	Coinsurance	Portion of charges an insured person must pay die covered healthcare services after the deductible	30
10749840409	Copayment	Specified amount a beneficiary must pay at the time of a healthcare encounter	31
10749840410	PCP	Primary care physician	32
10749840411	PPO	preferred provider organization	33
10749840412	Birthday rule	Guideline stating that the parent whose day of birth is earlier in the calendar year is primary	34
10749840413	coordination of benefits	Explains how an insurance policy will pay if more than one policy applies	35
10749840414	Self pay patient	Patient with no insurance	36
10749840415	Sequelae	Conditions that remain after an acute illness or injury has been treated and resolved	37
10749840416	Z code	Used to report encounters for circumstances other than a disease or injury	38
10749840417	ICD-10	Mandated code set for diagnoses under HIPAA	39
10749840418	Eponym	Name of phrase formed from or based on a persons name. Ex: Hodgkin's disease	40
10749840419	HIPAA	Health Insurance Portability and Accountability Act	41
10749840420	External cause code	ICD-10-CM code for an external cause of a disease or injury	42
10749840421	HMO	health maintenance organization	43
10749840422	HMO Definition	Managed healthcare system in which providers offer healthcare to members for fixed periodic payments	44
10749840423	Schedule of benefits	List of medical expenses covered by a health plan	45
10749840424	CPT	Current Procedural Terminology	46
10749840425	Preferred provider organization	Managed care organization in which a network of providers supplies discounted treatment for plan members. Most popular health insurance	47
10749840426	Protected Health Information (PHI)	Individually identifiable health information that is transmitted or maintained by electronic media.	48
10749840427	PCP	Physician in health maintenance organization who directs all aspects of a patients care	49
10749840428	Advanced beneficiary notice (ABN)	Form given to medicare beneficiaries indicating the charges patients need to pay	50
10749840429	Preventive medical services	Care provider to keep patients healthy or prevent illness	51
10749840430	NPP	Notice of Privacy Practices	52
10749840431	NPP DEFINITION	Notice of privacy that explains HIPAA	53
10749840432	Usual fee	normal fee charged by a provider	54