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Dr Madhu-S&T3
Dr Madhu S&T3
| Question | Answer |
|---|---|
| Assignment of Benefits | Transferring the right to collect payments from a insurance company from the patient to the doctor |
| Beneficiary | Person entitled to recieve benefits also called participant, subscriber dependent enrollee, or member. |
| Employer Indentification Number (EIN) | Number used by the IRS to identify a business for income tax reporting |
| Medigap | a term sometimes applied to private insurance products that supplements Medicare insurance benefits |
| Universal Claim Form | A form made by the Health Care financing Administration (now CMSI center for Medicare and Medicaid Services) used to submit all government sponsored claims |
| Allowed Charge | the most amount of money allowed for a procedure or service |
| Authorization | An approval for a procedure or referral |
| Utilization Review | When a case is reviewed to see if services are really needed and how medical resources are used. |
| Managed Care Plans | A term used for all healthcare plans that provide healthcare in return for a monthly fee using a set group of primary care doctors and hospitals |
| Medical Indigent | Someone who can pay for normal daily living expenses but cannont afford adequate health care. |
| Premium | the monthly, quarterly or annual payment of money to an insurance company for providing certain benefits |
| co-payment | The amount paid at the time of medical service |
| deductible | amount that must be paid out of pocket before the insurance company begins to pay |
| disability income insurance | insurance that provides money to replace income when someone is unable to work because of an illness, injury, or disease |
| exclusions | things (diseases, conditions) on an insurance contract for which benefits are not paid. |
| group policy | insurance that covers a group of people with a single contract usually through their employer |
| Worker's Compensation | Insurance against liability employer pay to give benefits to workers who are injured or killed on the JOB. |
| Clean Claim | An insurance claim form without ERRORS or Omissions |
| Dingy Claim | A claim that is delayed because it cannot be process |
| Dirty Claim | Claims that contain errors or omissions that cannot be processed or must be processed by hand |
| COB | Coordination of Benefits |
| HIPAA | Health Insurance Portability Accountability Act |
| HMO | Health Maintenace Organization |
| PAR | Participating Provider |
| RBRVS | Resurce Based Relative Value Systems |
Created by:
Tracy-
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