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Stack #31819

Mod C Unit 2 Words Thompson Institute hbg

assignment of benefits signing over benefits by the beneficiary to another party
beneficiary the person covered under the insurance policy
capitation the number of members to determine salary of the physician
claim demand of payment
coordination of benefits is used to determine which policy is primary
CPT current procedural terminology, used to look up codes for certain procedures
deductible fixed amount that must be paid first
dependents people that are covered under the same insurance policy
DRG diagnosis related groups, method in which hospitals are paid a flat fee
EOB explanation of payments
exclusions procedures not covered
existing condition an illness present at the start of insurance coverage
fee-for-service payment for services rendered at each visit
gatekeeper a PCP, or primary care physician
HCPCS health care procedural coding system used for Medicare claims
HMO requires a co-payment
ICD-9CM International Classification of Diseases, 9th Revision, Clinical Modification, used for coding diagnosis
PPO healthcare providers who network
provider participating physician
reciprocity license to work in another state
riders attachments to insurance policies
RVS resource value scale, codes used in Worker's Compensation claims
subscriber insured who holds the policy
Copayment insurance requirement for patient to pay a specific amount at time of Tx
Created by: shady123