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Mod C Unit 2 Words Thompson Institute hbg

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Words
Definitions
assignment of benefits   signing over benefits by the beneficiary to another party  
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beneficiary   the person covered under the insurance policy  
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capitation   the number of members to determine salary of the physician  
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claim   demand of payment  
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coordination of benefits   is used to determine which policy is primary  
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CPT   current procedural terminology, used to look up codes for certain procedures  
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deductible   fixed amount that must be paid first  
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dependents   people that are covered under the same insurance policy  
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DRG   diagnosis related groups, method in which hospitals are paid a flat fee  
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EOB   explanation of payments  
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exclusions   procedures not covered  
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existing condition   an illness present at the start of insurance coverage  
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fee-for-service   payment for services rendered at each visit  
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gatekeeper   a PCP, or primary care physician  
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HCPCS   health care procedural coding system used for Medicare claims  
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HMO   requires a co-payment  
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ICD-9CM   International Classification of Diseases, 9th Revision, Clinical Modification, used for coding diagnosis  
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PPO   healthcare providers who network  
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provider   participating physician  
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reciprocity   license to work in another state  
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riders   attachments to insurance policies  
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RVS   resource value scale, codes used in Worker's Compensation claims  
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subscriber   insured who holds the policy  
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Copayment   insurance requirement for patient to pay a specific amount at time of Tx  
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Created by: shady123
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