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Insurance Terms vol1
MOP 110 Ms. Ragadio
| Term | Definition |
|---|---|
| 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. |
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lolawhiterabbit
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