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Medical Insurance

QuestionAnswer
AFDC Aid to families with dependent children
CC Chief complaint, the main reason for today's visit.
EOMB Explanation of medicare benefits
Coding Process of assigning numerical code to a diagnosis and procedure or treatment
Diagnosis/DX Physicians opinion of a patients illness or injury
Tx Treatment
Premium The amount of money paid to an insurance company for an insurance plan
Benefit The amount of money an insurance carrier pays for services covered
Schedule of Benefits A list of benefits that an insurance company will pay
Dependents The spouse, children, and sometimes domestic partner or other individuals designated by the insured who are covered under a healthcare plan
Subscriber The person who buys an insurance plan
SOB Schedule of Benefits
OV Office Visit
Referral Transfer of patients specified care from physician to another
FICA Federal insurance contribution act
SSI Supplemental security income
PT Patient
Established Patient Patient has seen the physician within the past 3 years.
New Patient: A patient not seen by the physician within the past 3 years
Outpatient A patient who receives care at a medical facility but who inst admitted to the facility overnight, or for 24 hours or less
Inpatient a person admitted to a hospital for at least 24 hours
Consultation Service provided so that the physician can give advice to another physician about a patient
UCR Usual, customary, and reasonable fees.
UPIN Unique physician identifier number
EOB Explanation of benefits
ICD International classification of diseases
CPT Current, procedural terminology
Reimbursement Receiving payment for services rendered.
Assignment of Benefits Permission given by the insured that allows the insurance to pay directly to the physician.
Exclusions Situations that arent covered by the health insurance policy such as self inflicted injury
Network The group of doctors, hospitals and other health care providers that insurance companies contract with to provide services at discounted rates.
Out of Network Provider A health care professional, hospital or pharmacy that’s not part of a health plan's network of preferred providers.
Grace Period A time period after the payment is due, in which the policy holder may make a payment without penalty.
Claim A request by a plan member or a plan members health care provider for the insurance company to pay for medical services.
Created by: zainabgelle