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Insurance Terms vol1

MOP 110 Ms. Ragadio

fraud intentional deception or misrepresentation that could result in an unauthorized payment.
abuse actions inconsistent with accepted, sound medical, business, or fiscal practice.
scope of practice health care services, determined by the state, that an NP and PA can perform.
respondent superior Latin for "let the master answer"; legal doctrine holding that the employer is liable for the actions and omissions of employees performed and committed within the scope of their employment.
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.
stand-alone code CPT code that includes a complete description of the procedure or service.
medical malpractice insurance a type of liability insurance that covers physicians and other health care 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 the provider.
coinsurance also called coinsurance payment; the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid.
Created by: lolawhiterabbit