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Chap 1 CIMO

Computers in the Medical Office Chapter 1 Sanderson

policyholder a person or entity who buys an insurance plan; the insured
health plan a plan, program, or organization that provides health benefits
premium the periodic amount of money the insured pays to a health plan for insurance coverage
payer private or government organization that insures or pays for health care on behalf of beneficiaries
fee-for-service health plan that repays the policyholder for covered medical expenses
deductible amount due before benefits start
coinsurance percentage of charges that an insured person must pay for health care services after payment of the deductible amount
managed care a type of insurance in which the carrier is responsible for both the financing and delivery of health care
preferred provider organization (PPO) managed care network ofhealth care providers who agree to perform services for plan members at discounted fees
health maintenance organization (HMO) a managed health care system in which providers agree to offer health care to the organization's members for fixed payments
capitation payment to a provider that covers each plan member's health care services for a certain period of time
copayment a fixed fee paid by the patient at the time of an office visit
consumer-driven health plan (CDHP) a type of managed care with a high deductible, low premium insurance plan combined with pretax savings account to cover out-of-pocket medical expenses
patient information form a form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim
documentation a record of health care encounters between physician and the patient
medical record chronological record of a patient's medical history and care
diagnosis physician's opinion of the nature of the patient's illness or injury
procedure medical treatment provided by a physician or other health care provider
coding the process of translating a description of a diagnosis or procedure into a standardized code
diagnosis code standardized value that represents a patient's illness, signs, symptoms
procedure code code that identifies a medical service
modifier two-digit character appended to a CPT code to report special circumstances
encounter form list of the procedures and charges for a patient's visit
electronic health record (EHR) computerized lifelong health care record for an individual that incorporates data from providers who treat the individual
practice management program (PMP) software program that automates many of the administrative and financial tasks in a medical practice
medical coder person who analyzes and codes patient diagnoses, procedures and symptoms
medical necessity treatment provided by physician for the purpose of preventing, diagnosing, or treating an illness, injury or symptoms; generally accepted medical practice
adjudication series of steps that determine whether a claim should be paid
remittance advice (RA) an explanation of benefits transmitted electronically by a payor to a provider
explanation of benefits (EOB) paper document from a payer that shows how the amount of a benefit was determined
statement a list of all services performed for a patient, along with the charges for each service
accounting cycle the flow of financial transactions in a business
accounts receivable (AR) money that is flowing into a business
Created by: erosok
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