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Stack #31819
Mod C Unit 2 Words Thompson Institute hbg
| Words | Definitions |
|---|---|
| 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
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