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Mod C
Unit #2
| Term | Definition |
|---|---|
| assignment of benefits(current proc | signing over benefits bye the beneficiary to another party |
| beneficiary | the person covered under the insurance policy |
| capitation | the number of members to determine salary of the physician |
| claim | demand of payment |
| COB | (coordination of benefits) is used to determine which policy is primary |
| CPT | (current procedural terminology, used to look up codes for certain procedures |
| deductible | fixed amount that must be paid first |
| dependents | people that are covered under the same insurance policy |
| DRG | (diagnosis related groups) method in which hospitals are paid a flat fee |
| EOB | (explanation of benefits) |
| exclusions | procedures not covered |
| existing condition | an illness present at the start of insurance coverage |
| fee-for-service | payment for services rendered at each visit |
| gatekeeper | a PCP, or primary care physician |
| HCPCS | (health care proecedural coding system) used for medicare claims |
| HMO | requires a co-payment |
| ICD-9CM | (International classification of diseases, 9th revision, clinical modification) used for coding diagnosis |
| PPO | healcare providers who network |
| provider | participating physician |
| reciprocity | license to work in another state |
| riders | attachments to insurance policis |
| RVS | (resource value scale), codes used in worker's compensation claims |
| copayment | insurance requirement for patient to pay a specific amount at time of TX |
| subscriber | insured who holds the policy |
Created by:
tbarger
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