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Insurance/coding
medical terms
| Term | Definition |
|---|---|
| Beneficiary | Person under a policy to receive benefits |
| Birthday Rule | Parents bday who falls first in the calendar year to determine what insurance is billed first |
| Coinsurance | fixed percentage; usually 80/20 |
| Copayment | Payment required at each visit when seen by the provider |
| Deductible | the amount that must be paid by the insured before the policy will begin to pay |
| Exclusion | specific disease or condition not covered under the plan |
| Outsourcing | to contract out |
| Preauthorization | obtaining consent to proceed with patient care and treatment |
| Primary Care Provider | PCP/ Primary care physician/one who oversees patients primary health |
| Referral | obtaining consent to be seen by another provider or specialist |
| UCR | Usual; Customary and reasonable fee schedule used by some insurance companies |
| Worker's Compensation Insurance | insurance for workers who are hurt OR injured on the job |
| ICD-10CM | Standard diagnosis codes |
| CMS-1500 | The universal claim |
| Encounter Form | Charge slip, super bill |
| HCPCS | Healthcare Common Procedure coding system, DME: Durable medical equipment |
| Modifier | additional information added to a code |
| Up-Coding | Over coding |
| V-Code | External cause of injury |
| Z-Code | the reason for the visit other than the present illness |
Created by:
Bbailey6160
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