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Medical Insurance 2

Med insurance

QuestionAnswer
Release of Information Legal document that authorizes info to be released to a medical insurance carrier
IPA Independent practice association
HMO Health maintenance organization
Primary Diagnosis A patients major health problem
Attending Physician The physician in charge of patient care
TAR Treatment authorization request
Provisional Diagnosis A tempo diagnosis made prior to receiving actual test results
Workers Compensation Insurance to cover work related injuries and illness
EMR Electronic medical record
TPO Treatment payment operations
Pre-existing Condition Diagnosis before insurance policy was written
CMS Centers for medicare and medicaid services
TriCare Provides military personnel with health care
PPO Preferred provider organization
Carrier A company that assumes the risk of an insurance policy
Birthday Rule When covered under two insurances, use the insurance policy of the policy holder who's birthday comes first.
COB Coordination of Benefits
Group Policy Policy that covers several people on a master contract
Emancipated Minor Person who isnt 18 but has the same legal rights as an adult
Balance Billing Billing the patient for the amount not covered by insurance
Medical Necessity The process of establishing the medical need for medical services
Write off Difference between a full fee and an allowed fee
Disability Lack of ability to perform in a range considered normal
Allowed charge Max amount insurance company pays for service
Managed Care A health care system whose goals are to provide cost effective quality care.
Co-payment The portion of a service fee that the patient must pay
Delinquent Claim Claim with payment overdue
Walk out statement Printed form with estimated charges that patient takes with them
Gate Keeper Term given to primary care physician for coordinating the patients care
Accident An unexpected happening that may result in injury, loss, or damage.
Grievance Procedure a provision for resolving issues that may come up later
Lapse Termination of insurance coverage for lack of insurance payment
Probationary Period Waiting period when certain pre existing conditions are excluded
Waiver a document that shows a person voluntarily gives up a right, claim or privilege
Disability income insurance Provides income to those who are injured and unable to work
Created by: zainabgelle