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med manager
vocab
| Question | Answer |
|---|---|
| signature date | the date on which a document was signed |
| Policy holder | This is the individual who owns the insurance policy. This person must be the guarantor or one of the depents on the account |
| Consent | Under the HIPAA Privacy rule, the pt. gives consent to the use of his or her protected health info by the medical practicefor the purpose of treatment, payment, and operating of the health care practice.Pt signs a consent form. |
| Default response | The info that appears automatically when ENTER is pressed. Default response speed up data entry report selections.This is most common response for a given entry. you may press ENTER to accept the (DR)for any field for which info is not provided. |
| New insured party | This is a Medical Manager routine for entering the pt.'s personal and insurance info |
| Primary insurance | This is the insurance company that is mainly responsible for paying a claim. Therefore, this is the company that is billed first |
| Insured | An individual or organization protected in case of loss under the terms of an insurance policy.In practice the insured person(party)is the person who owns the policy. The insured is usually the party who buys the policy from th insurance Co. and who pays. |
| Dependents | Person who may receive services on someone else's account. They are not the guarantor but the guarantor does agree to be financially responsible for the care of the the dependent receives. Dependent may be a spouse, child, parent, partner |
| Extended informantion | This is considered additional pt. locating information such as work, school, or even where a pt. may be a volunteer during the day |
| Assignment of benefits | The act by which a pt. assigns in writing to their physician the right to receive $ directly from the pt.'s insurance carrier. |
| Group number/Name | This is a field on the Insurance Policy screen that allows you to specify who the group policy belongs to. So if pt. is insured through his employer, the employer mane would be entered at the Group Name/number" field |
| Insurance coverage priority | This is info set in the Insurance Coverage Priority screen in the system that establishes the insurance policy or policies a pt is covered by. Determines which plan is to be billed first for the pt.'s charges & if applicable, other plan rest of charges |
| Insurance I.D number | An I.D # is assigned by the insurance company to identify a particular insurance policy. It is sometimes called a subscriber number, policy number, or identification (insurnace) number. |
| Group Name | |
| Patient registration form | PT. completes when first sets up their account @ the medical practice. Contains the pt.'s full name, address/telephone #, SS #, DOB, employment info, insurance plan info, & similar info for each dependent |
| referring doctor | This is a physician who refers their pt.'s to another physician, often a specialist, for more in-depth care. For example if pt. breaks their arm they would be sent to an Orthopedic specialist |
| secondary insurance | This is the insurance company that is billed for any remaining charges(minus copayments & deductibles) after the primary insurance company has been billed. This is not uncommon |
| patient's account number | A tracking # that uniquely identify each pt. and all of the individual transactions inside the practice |
| guarantor | the person who agrees to be financially responsible for the account. |
| Encounter form | This is a printed list of the most common procedures and treatment performed by the doctor. The doctor uses this to indicate the procedures and treatment performed for the pt. and as well as the diagnosis for the pt.'s condition |
| Medicaid | a financial assistance program sponsored jointly by the fed and the state to provide health care for the poor. |
| Medicare | an insurance program sponsored by the federal government to protect the elderly and disabled population. |
| worker's compensation | insurance that covers medical expenses uncured as a result of a work-related injury or disability. This insurance, paid by employers, also pays the salary of an employee who is unable to work, due to the injury or disability. |
| responsible party | the person or in some cases, the organization responsible for paying part or all the pt.'s bills |
| new guarantors full report | A comprehensive report run to verify the accuracy and completeness of data entry for new guarantors |
| insurance type | refers to the category of insurance carried by the pt.. for instance the type may be private insurance workers' comp insurance, ect.... |
| insurance policy information | The name and location of the insurance company to which claims are to be sent for each pt. Each pt.'s insurance plan info must be entered completely so that the practice will know what insurance the pt. is covered by & what medical procedures are covered |
| guarantor's full report | provides pt. personal info , extended info and insurance info from the guarantor's file. Could be printed for all or specific guarantors of all accounts in the system. It may be generated in either the Guarantor's Summary Report or the GFR |
| CHAMPVA | A government insurance program for veterans and their dependents. |
| insured party record | An individual record maintained inside the Insured Party File |
| Batch total | running total, calcutlated by the system, which is shown throught the duration of a posting session |
| Patient Statement | producess a list of the outstanding charges in a pt.'s account |
| Claim form | a document sent to the insurance company to request payment for services that were performed for the pt. |
| CMS 1500 | This health insurance claims form contains spaces for info that is mostly typically requested by insurance companies and is accepted by most government and provate insurance companies |
| Posting | The activity of recording business transaction such as the process of typing information from a source document, such as an encounter form, into the Procedure Entery screen; or typing in payments from an EOB to the Patient Payments window |
| Trial daily report | allows the practice the ability to verify or correct the dialy financial data entries before a Daily Close |
| Insurance billing worksheet | allows you to verify that previous info was entered correctly b4 you print claim forms and send them to the insurance company for payment. You can view procedure, diagnosis and assignment info for each pt. |
| Transfer responsibility | the ability in Payment Entry to change responsiblilty for the charges on an open item from one insurance company to another or from insurance responsibility to pt responsibilty.(T)ransfer option on the Payment Entery screen |
| Place of sevice (POS) | series of standardized codes that indicate the place where the doctor saw the pt. or performed the procedure. |
| Explamation of benefits (EOB) | An insurance company document that accompanies paymant( or explains the lack of payment) fir a particular pt.'s charges |
| Check register | Part of the Daily Closefunction that lists all checks posted during 1 day |
| Adjustments | To keep the doctor's books and the pt.'s ledger in balance, any change in the original charge mist be accounted for. |
| Auto pay | A method in the Payment Entry phase that allows the computer to allocate automatically payments to serval open items. (A)uto Pay |
| Unapplied credit | Payments for a pt.'s account that have not been allocated to individual open items are called unapplied credit. |
| Ailment detailed | In-depth info about an illness or injury tha is always required for Workers Comp claims and sometimes needed for other claims |
| Write off | bring an account to a zero balance |
| Patient statement | a feature producess a list of outstanding charges in a pt.'s account |
| Allocate payment | refers to assigning a payment amount to an outstanding charge or charges |
| Electronic media claims | refers to electonic claims that are sent over the telephone, using a modem |
| Medicare approved amount | The maxium amount that a Medicare participating provider may collect for performing a procedure |
| Cancel reason code | often defined by the practice, to indicate why an appt is cancelled. |
| Hospital rounds | visits by physican makes to pt.'s whoe are in the hospital |
| Units | refers to the number of times the procedures was repeated during the date or dates of service |
| Dual insurance coverage | refers to the cases in which a pt is insured by more than one insurance plan |
| Status code P= | Payment |
| Status code I= | Insurance |
| Status code PT= | transfer to patient |
| Status code IU= | pending insurance |
| Status code IR= | item pending (rebilled) |
Created by:
bpstears
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