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Chap 11AR

Claims Process

A & P anterior and posterior
A before
ANT anterior
A/O alert and oriented
ASAP as soon as possible
bid twice a day
BIL bilateral
BP blood pressure
BS bowel sounds, breathing sounds
c/o complains of
C1-7 cervical vertebrae
CAD coronary artery disease
CC cheif complaint
CHD congenital heart disease
CHF congestive heart failure
CNT could not test
CON congested
COPD chronic obstructive pulmonary disease
CP chest pain
CV cardiovascular
CVA cerebrovascular accident
D/C discontinue
DDD degenerative disk disease
DIST distal
DJD degenerative joint disease
DM diabetes mellitus
DOB date of birth
DOE dyspnea on exertion
DOI date of injury
DVT deep vein thrombosis
Dx diagnosis
ed edema
EENT eye, ear, nose, and throat
Eval evaluate
ext extremity
EXT external, extension
ext. rot. external rotation
FH family history
FLEX flexion
FROM full range of motion
ft foot
Fx fracture
GERD gastroesophageal reflux disease
GI gastriointestinal
GYN gynecologic, gynecological
HA head ache
HBP high blood pressure
HPI history of present illness
hs at bedtime
HTR hypertrophy
Hx history
IHD ischemic heart disease
IM intramuscular
INFLAM inflammation
INT internal
int. rot. internal rotation
IV intravenous
jt joint
KUB kidneys, ureter, bladder
L left
L1-5 lumbar vertebrae
Lat lateral, left anterior thigh
Lats latissimus dorsi
LB low back
LBP low back pain
LE lower extremities
LLQ left lower quadrant (abdomen)
M murmur
mas massage
SOB shortness of breath
SOBOE shortness of breath on exertion
SP spasm
spr sprain
SQ or SC subcutaneous
S&S or S/S signs and symptoms
stat immediately
STI soft tissue injury
str strain
SUP superior, supination
Sx symptoms
T1-12 thoracic vertebrae
TIA tansient ischemia attack
tid three times a day
TMJ temporal mandibular joint
TMJD temporal mandibular joint dysfunction
TP trigger point
TPR temperature, pulse, respiration
Tx treatment, therapy
UE upper extremity
UTI urinary tract infection
VV vericose vein
WNL within normal limits
x times
y/o years old
capitation rate paid to participating physicians on a per person bases, based on age and sex whether the patient utilizes services or not
rule for waiving copayments illegal (write on test)
disallowed amount difference between billed amount and the allowed amount
oldest type of prepaid health plan HMO
professional review organization determines and assures the quality and operation of health care
utilization review controls costs
carve outs medical services that are not included in the capitation list
churning when a physician sees a patient more than is medically necessary
PPO organization gives members freedom of choice
another name for PCP gatekeeper
preauthorization seeking approval of services before seeing a specialist or obtaining radiology services
withholding certain % of monthly capitation payment is held out of payment to pay for operating an IPA
Managed Care Organization MCO
can a person who is eligible for Medicare still have an HMO or prepaid health plan yes
staff model HMO physician hired directly by the health plan that pays their salary
Created by: maxphia32