Mod C Unit 2 Words Thompson Institute hbg
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| 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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