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Chap 1 CIMO
Computers in the Medical Office Chapter 1 Sanderson
| Question | Answer |
|---|---|
| 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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