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Final Exam 99 words

99 definitions for Medical Office final exam

Accellerator Key is used to move ahead quickly; it allows the user to perform another function by choosing the appropriate key
Accept Assignment checking yes in this box informs the insurance company that the physician/practice is agreeing to accept allowed amounts of the payer
Account Adjustment any adjustment to the account (+/-)
Accounts Receivable money coming into the practice
Admitting Diagnosis the initial reason for admission to a hospital,even though that latter may be changed/updated
Aging Report report that shows open insurance/patient account balances and how long they have been due (always shows 30+ days)
Allowed Charge/Allowed Amount the maximum amount thqat the inusrance company will pay on a CPT/HCPCS
Alphanumeric data entry consisting of #'s and letters
Appointment Schedule A listing of patients to be seen at any given time
Assignment of Benefits the patient signs an authorization form that allows the practice to receive reimbursement directly from the payer
Back-up done daily to secure a copy of the info entered and saved on the computer
Batch a group of claims sent together electronically
Billing Routine is the way in which a specific office performs it's regular billing activities a such as transactions entry and monthly statement generation
Birthday Rule A ruling that decides the primary insurance for dependents where there are two or more policies providing coverage The rule states that the first birthday of the policy holders falling first in the calander year is the primary insurance
Bundled Code A CPT that represents more than one individual procedure or service
Carrier the name and address to which claims are sent
Case In Medisoft, is a group of claims grouped together with one thing in common (ex. ins co, Dx, etc)
Charge Slip Super Bill, Patient encounter form, A listing of the most commonly performed procedures used in the practice for billing. Also includes pt. name, ins/referral info. payment info, provider info
Chart Number usually consists of 8 characters and is used internally by the practice to ID the patient in the software (Medent uses account numbers)
Charting the provider's entries into the medical record
Checkbox activating this will cause software to perform a specific function
Clearing House this company is contracted to view electronic claims for completeness, then forward them to the carrier (They don't correct claims)
CMS1500 is a standardized claim form used by MD offices
Comprehensive Insurance combines both basic and major medical coverage
Consultation is when a patient is seen by another provider to either confirm Dx or provide a 2nd opinion on a proposed Tx
Coordination of Benefits COB a ruliing that allows for non-duplication of benefits where there is more than one insurance company providing coverage on a patient
Co-payment a small amount of money paid at each visit for service (co-insurance)
CPT Codes these represent the service or procedure rendered to the patient; Current Procedural Terminology
Credit whether it is an adjustment or a payment it reduces the amount owed on the account
Daily Close/Daysheet Daysheet/Daily close- is another term for the report that lists transactions to patient account and is done daily
Debit will increase the amount of the account from what it originally was
Deductible the portin that a patient must pay (out of pocket) before insurance will make payments
Dependents people covered under the insured's contract and usually includes spouse, unmarried children
Diagnosis provider's opinion of the condition/illness of patient
Disability temporary or perminant, it is the time period during which a patient cannot perform usual activities
Edit Patient Screen some softwares have a specific area to edit patient information
Elective Surgery A procedure that is not a medical necessity
Electronic Claims Media claims submitted electronically using a modem
Electronic Signature is produced by making a selection in the software that allows for the providers endorsement to be produced on a given document
Encounter Form SuperBill, Charge slip
Explanation of Benefits EOB is a financial statement (usually accompanies payment) sent from the insurance company that lists payments, write-offs, amounts applied to deductables, patient responsibilities amounts and/or reason for non-payment
Faciilty a provider of services (ex. hospitals, labs, etc.)
Fee Schedule is a list of defined charges used for billing services or it is the list of CPT's and HCPCS's and their allowed amounts
Field in a medical software package data is entered into a specific field (ie. name, address, ins. policy, policy holder, etc.)
Folder a place where files are stored on the computer
General Ledger a report of all financial details of the business which includes all expenses and incomes of the business
Global Fee A fee charged for all care related to the man procedure (ex. patient would not be charged post-op visits for F-up
Global Period A specific time period which the patient will receive treatment related to the primary procedure with no additional charges
Group shows who the policy belongs to
Guarantor the personnamed to insure payment of the patient's acount (not necessarily the patient)
Health Maintenance Organization HMO is a type of managed care plan that has several types of providers that service patients in one facility
ICD-9 Codes codes that represent the diagnosis(illness, condition, disease) of a patient; International Classification of Diseases, 9th revision, Clinical Modifications
Icon a picture that you click on to select an option or use a particular application (shortcut to applications or part of the application)
Inpatient a person receiving hospital care for 24+ hours
Insurance ID number created by insurance companies, ID # is put on claims to identify patient and coverage for that patient
Insured/Insured Party policy holder, subscriber, is the person who contracted with the insurance company
Main Menu the start point in any software, helps to direct you through the software through a series of options
Malpractice Improper/negligent medical care
Medicaid a government sponsored insurance that provides coverage for lower income patients (sponsored by state, some federal)
Medicare a government sponsored insurance that provides coverage for elderly, disabled, ESRF (sponsored by federal)
Modifier a two digit code that alters the reason for billing a specific CPT/HCPCS. It further explains why/how something was done
Non-participating provider provider who has not contracted with the insurance company does not have to accept their allowed charges meaning the patient can be billed for the difference between what the insurance company paid and what the doctor is billed
Open Items on a patient account are CPT/HCPCS that have been fully paid or adjusted for
Outpatient patient receiving hospital care for less than 24 hours
Participating provider a provider who has contracted with an insurance company agreeing to it's fee schedule provisions
Password to insure access only by authorized individuals and to limit certain areas of software this is issued
Patient Ledger a financial record detailing all charges, payments and adjustments to a patient's account
Patient Registration Form is filled out at the initial viasit of the patient and shoulc be updated periodically to insure correct address, phonem, insurance and/or dependents
PCP primary care physician
Place of Service Code POS represents the place at which services were rendered by provider (school, hospital, home, nursing home, etc)
Policy Holder subscriber, insured/insured party
Posting an Account applying payments, adjustments, and/or write-offs to an account
Premium the amount a person pays to the company for coverage
Primary Insurance The insuance billed first which usually pays the greater portion of the claim
Prior Authorization Insurance companies require review of certain procedures before they will agree to consider payment. This is done by calling them before the procedure, providing related information and obtaining a reference # for this
Procedure Codes same diference as CPT codes
Prognosis Physician's prediction of future condition or outcome of the patient
Provider the person rendering health care services
Receipts given as proof of payment
Referral is issued by the pcp to allow the patient to be seen by another physician/specialist for a certain reason. The insurance company can refuse coverage if this is not done
Responsible Party Guarantor- ia the person who agrees to insure payment of the patient's account
Rider an ammendment to an insurance policy may add additional coverage or impose restrictions
Right Click allows you to use more options to become available quickly (brings up a menu with options)
Secondary Insurance after a primary insurance has been responded and handled by the biller, the next step is to bill the secondary insurance (COB- coordination of benefits)
Specialist a physician who has specialized training
Status Bar located at the bottom of the screen and shows what the user is currently working on/in
Subscriber policy holder, insured/insured party
Superbill charge slip, encounter form
Support Files lists of stored information on software for future or repeated use
Third Party Payer also refered to as the carrier are billed for services done to the patient and reimburse the physician
Type of Service Code TOS coincides with the procedure rendered such as medical or surgical
UB-04 Form standardized claim form used by hospitals
Unbundle to seperate into seperate CPT code two or more seperate codes
Units (in a transaction entry) represents the number of times that a service/procedure was done on a given day
Voucher Explanation of Benefits EOB In other businesses serves as an invoice
Walk-out Receipt given to patients at checkout showing charges and payments for that day of service DOS
Worker's Compensation Insurance which businesses have coverage for their employees to cover on the job injuries
Write-off the difference between the amount charged (by the provider) and the allowed amount (amount allowed by the insurance company)
Created by: StarAngel223