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billing and coding 2
medical billing and coding chapter 2
| Term | Definition |
|---|---|
| coinsurance | predetermined percentage the patient is responsible to pay for covered services. |
| copayment | fixed amount that a patient pays for specific services. |
| covered benefits | services outlined in the policy that re payable by the health plan. |
| deductible | amount patient must pay before the insurance will begin to pay for covered benefits. |
| HMO | health maintenance organization. contracted providers that agree to the payment contract for its members. |
| noncovered services | services that are not payable by the health plan. |
| out-of-network | a provider who does not have signed agreement with an insurance plan. |
| policyholder | the individual who signs a contract with a health insurance company |
| PPO | preferred provider organization. providers join networks and are consider preferred when a patient seeks treatment. |
| ICD-10-CM | international classification of disease, 10th revision, clinical modification. |
| Medical record | contains facts, findings, and observations about a patient’s health. |
| Malpractice | a failure to use professional skill when giving medical services that results in injury or harm. |
| EHR electronic health record | are computerized, lifelong healthcare records with data from all sources. |
| Revenue Cycle with Medical Documentation | Both billing information and clinical information are collected from the patient and documented. |
| HIPPA | protect private health information, ensure coverage, uncover fraud and abuse, and create industry standards |
| Clearinghouse | Company that converts nonstandard transactions into standard transactions and transmits the data to health plans |
| who does a patients medical record belong to? | Medical record belongs to the provider who created it |
| Breach | impermissible use or disclosure of hippa that could pose significant risk to the affected person. |
| Fraud | intentional deceptive act to obtain a benefit by taking advantage of another person |
| PHI | individually identifiable health information transmitted or maintained by electronic media |
| Premium | the amount a patient pays each amount to receive service. |
Created by:
trayona02
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