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chpter 14 & 15


authorization by the pt. to allow the Dr. to get paid directly from insurance Assignment of benefits
Fixed amount of money paid toward the charge for professional services rendered at the time of service Copayment
established for the spouses and dependent children of vets who have total, permanent service connected disability CHAMPVA
When a health care provider is paid a fixed amount per member per month for each pt. who is a member of a particular insurance whether or not services were provided Capitation
Joint funding's program by federal and state government for the medical care of low income pt.'s on public assistance Medicaid
A predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness Deductible
Procedures used by insurers to avoid duplication of payments on claims when a pt. has more than one insurance policy Coordination of benefits
a group insurance that entitles members to services provided by participating hospitals, clinics, and physicians Health Maintenance Organization (HMO)
government program that provides insurance coverage for those who are injured on the job or who have developed work related disorders disabilities or illnesses Workers Compensation
approval obtained before the pt. is admitted to the hospital or receives specified outpatient or in office procedures Precertification
commercial plan in which the insurance company or group reimburse physicians or beneficiaries for services Indemnity plan
health insurance for the elderly disabled and end of stage renal disease Medicare
established to aid the dependents of active duty service personnel, retired personnel and the dependents, and service personnel who died on active duty TRICARE
health delivery system that combines the delivery of health care and payment services Manage care
date when the insurance policy goes into effect Effective date
a condition that exists before the insured's policy was issued Preexisting condition
person who is insured and insurance policy holder Subscriber
geographic area served by an insurance carrier Service area
Insurance purchased by an individual or family who does not have access to group insurance Individual insurance
insurance offered to all employees by the employer Group insurance
method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of care prior to the delivery of care Utilization management
manual that list all the procedures codes for service rendered CPT
a diagnosis manual that lists all diagnoses and they must correspond with the CPT manual ICD-9
99201-99499 Evaluation and Management
10021-69990 surgery
80047-89398 pathology and Lab
70010-79999 radiology
00100-01999, 99100-99140 Anesthesiology
90281-99199, 99500-99607 Medicine
A 00
S 10
R 70
P 80
M 90
E 99
Created by: bpstears