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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 |