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MB101 Ch 2A

Intro to medical billing

The identification of disease, and the care and treatment to persons that are sick or injured medical care
medical care plus preventive services health care
a contract between the subscriber and the insurance company to pay for all or part of health care health insurance
Insurance providing income to a policyholder who is temporarily or permanently disabled and cannot work disability insurance
covers losses to a third party caused by the insured or property of the insured; covers medical care, lost wages and pain/suffering liability insurance
Federal legislation that requires employers to cover medical expenses and lost wages for workers injured on the job Workers compensation
Federal legislation that allows employees to continue health care beyond their termination date - must pay premiums COBRA
Provided grants to modernize hospitals; in return, hospitals must provide care to those in need at free or reduced cost Hill-Burton Act
A physician or other health care practitioner provider
A provider who has signed a contract with an insurance company; agrees to accept what insurance pays as payment in full participating provider
A provider who is not under contract with an insurance company; is allowed to charge patient the difference between charge and reimbursement nonparticipating provider
The person who has the insurance policy - in their name policyholder
a person covered under a policyholder's insurance plan dependent
a person responsible for paying the patient's account guarantor
A patient without health insurance that must pay out of pocket for care. self-pay
The insurance plan that is billed first primary insurance
the insurance plan that is billed second secondary insurance
States that the plan of the policyholder whose birth day and month comes first in year is primary Birthday rule
The provider accepts as payment in full what the insurance pays. Accept assignment
The patient gives permission for payment to be sent to the provider. Assignment of Benefits
The amount the patient is responsible for paying before any reimbursement is issued by the insurance policy deductible
A percentage the patient is responsible to pay of the cost of medical services. coinsurance
a flat fee the patient pays each time for medical services copayment
The dollar amount an insurance company deems fair for a specific service or procedure allowed charge
Determines the allowed charge; based on physician work, practice expense, and malpractice insurance costs RBRVS
A list of allowed charges for all services and procedures payable by the insurance company fee schedule
Hospitalization, labs, x-rays, surgical fees, OB care, newborn care, intensive care, chemo Basic coverage
office visits, outpatient, PT and OT, DME, mental health, allergy testing, Rx drugs Major medical
Any condition that was diagnosed and/or treated before a patient's effective date of their insurance policy preexisting condition
Paper form used to file medical claims for physician and outpatient services CMS 1500
Created by: Kirkster