Vocabulary
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| authorization by the pt. to allow the Dr. to get paid directly from insurance | Assignment of benefits
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| Fixed amount of money paid toward the charge for professional services rendered at the time of service | Copayment
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| established for the spouses and dependent children of vets who have total, permanent service connected disability | CHAMPVA
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| 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
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| Joint funding's program by federal and state government for the medical care of low income pt.'s on public assistance | Medicaid
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| A predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness | Deductible
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| Procedures used by insurers to avoid duplication of payments on claims when a pt. has more than one insurance policy | Coordination of benefits
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| a group insurance that entitles members to services provided by participating hospitals, clinics, and physicians | Health Maintenance Organization (HMO)
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| 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
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| approval obtained before the pt. is admitted to the hospital or receives specified outpatient or in office procedures | Precertification
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| commercial plan in which the insurance company or group reimburse physicians or beneficiaries for services | Indemnity plan
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| health insurance for the elderly disabled and end of stage renal disease | Medicare
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| established to aid the dependents of active duty service personnel, retired personnel and the dependents, and service personnel who died on active duty | TRICARE
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| health delivery system that combines the delivery of health care and payment services | Manage care
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| date when the insurance policy goes into effect | Effective date
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| a condition that exists before the insured's policy was issued | Preexisting condition
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| person who is insured and insurance policy holder | Subscriber
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| geographic area served by an insurance carrier | Service area
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| Insurance purchased by an individual or family who does not have access to group insurance | Individual insurance
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| insurance offered to all employees by the employer | Group insurance
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| 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
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| manual that list all the procedures codes for service rendered | CPT
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| a diagnosis manual that lists all diagnoses and they must correspond with the CPT manual | ICD-9
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| 99201-99499 | Evaluation and Management
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| 10021-69990 | surgery
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| 80047-89398 | pathology and Lab
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| 70010-79999 | radiology
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| 00100-01999, 99100-99140 | Anesthesiology
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| 90281-99199, 99500-99607 | Medicine
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| A | 00
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| S | 10
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| R | 70
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| P | 80
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| M | 90
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| E | 99
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| THE PARENT WHOSE B-DAY COMES FIRST IN THE CALANDER YEAR IS PRIMARY | Birthday rule
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