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chpter 14 & 15
Vocabulary
| Question | Answer |
|---|---|
| authorization by the pt. to allow the Dr. to get paid directly from insurance | Assignment of benefits |
| Fixed amount of money paid toward the charge for professional services rendered at the time of service | Copayment |
| established for the spouses and dependent children of vets who have total, permanent service connected disability | CHAMPVA |
| 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 |
| Joint funding's program by federal and state government for the medical care of low income pt.'s on public assistance | Medicaid |
| A predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness | Deductible |
| Procedures used by insurers to avoid duplication of payments on claims when a pt. has more than one insurance policy | Coordination of benefits |
| a group insurance that entitles members to services provided by participating hospitals, clinics, and physicians | Health Maintenance Organization (HMO) |
| 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 |
| approval obtained before the pt. is admitted to the hospital or receives specified outpatient or in office procedures | Precertification |
| commercial plan in which the insurance company or group reimburse physicians or beneficiaries for services | Indemnity plan |
| health insurance for the elderly disabled and end of stage renal disease | Medicare |
| established to aid the dependents of active duty service personnel, retired personnel and the dependents, and service personnel who died on active duty | TRICARE |
| health delivery system that combines the delivery of health care and payment services | Manage care |
| date when the insurance policy goes into effect | Effective date |
| a condition that exists before the insured's policy was issued | Preexisting condition |
| person who is insured and insurance policy holder | Subscriber |
| geographic area served by an insurance carrier | Service area |
| Insurance purchased by an individual or family who does not have access to group insurance | Individual insurance |
| insurance offered to all employees by the employer | Group insurance |
| 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 |
| manual that list all the procedures codes for service rendered | CPT |
| a diagnosis manual that lists all diagnoses and they must correspond with the CPT manual | ICD-9 |
| 99201-99499 | Evaluation and Management |
| 10021-69990 | surgery |
| 80047-89398 | pathology and Lab |
| 70010-79999 | radiology |
| 00100-01999, 99100-99140 | Anesthesiology |
| 90281-99199, 99500-99607 | Medicine |
| A | 00 |
| S | 10 |
| R | 70 |
| P | 80 |
| M | 90 |
| E | 99 |
| THE PARENT WHOSE B-DAY COMES FIRST IN THE CALANDER YEAR IS PRIMARY | Birthday rule |
Created by:
bpstears
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