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Insurance terms.1

insurance terms

TermDefinition
Abuse actions inconsistent with accepted, sound, medical, business, or fiscal practices
Fraud Intentional deception or misrepresentation that could result in an unauthorized payment
Medical Malpractice Insurance A type of liability insurance that covers physicians and other healthcare professionals for liability claims arising from patient treatment
Medical Necessity Involves linking every procedure or service code reported on an insurance claim to a condition code that justifies the need to perform that procedure or service
Preauthorization Prior approval
Remittance Advice (remit) Electronic or paper-based report of payment sent by the payer to provider; includes patient name, patient health insurance number, facility provider number/name, dates of service, type of bill (TOB), charges, payment information, and reason/remark codes
Respondent Superior Latin for "let the master answer"; legal doctrine holding that the employer is liable fro the actions and omissions of employees performed and committed within the scope of their employment
Scope of Practice Health care services, determined by the state, that an NP and PA can perform
Stand-alone Code CPT code that includes a complete description of the procedure or service
Statute of Limitations A statute prescribing a period of limitation for the bringing of certain kinds of legal action
Subpoena An order of the court that requires a witness to appear at a particular time and place to testify
Coinsurance Also called coinsurance payment; the percentage the patient pays for covered services after the deductible has been met and the copayment has been met
Created by: 1berev2