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Mode 4010 wk 1

4010 1Terms and Abbreviations

Ethics standards of conduct generally accepted as a moral guide for behavior by which an insurance billing or coding specialist may determine the appropriateness of his or her conduct in a relationship with the patients, the physician, co-workers, the government
Etiquette Customs, rules of conduct, courtesy, and manners of the medical profession
Capitation a system of payment used by managed care plans in which physicians and hospitals are paid/ fixed per capita amount for each patient enrolled over a stated period of time regardless of the type and number of services provided
Expressed Contract A verbal or written agreement
Respondent Superior "Let the Master answer" refers to a physician's liability in certain cases for wrongful acts of his assistant(s) or employee(s)
Accounts Receivable Management The organization and administration of coding and billing in a medical practice
Guarantor An individual who promises to pay the medical by signing a form agreeing to pay or who accepts treatment, which constitutes an expressed promise.
Implied Contract Not manifested by direct words but implied or deduced from the circumstances
Medicaid A federally aided state operated and administered program that provides medical benefits for certain low income families
Medicare A nationwide health insurance program for those who are 65 years old and older
Medicaid/Medicare(Medi/Medi) Refers to an individual who has both Medicaid and Medicare benefits
Principle Diagnosis A condition established after study that is chiefly responsible for the admission of the patient into the hospital
Discharge Summary various services provided that prepare the patient for discharge from the inpatient facility
Fraud An intentional misrepresentation of the facts to deceive or mislead another
Medical Necessity The performance of services and procedures that are consistent with a diagnosis in accordance with standards of good medical practice performed at the proper level and provided in the most appropriate setting
DIAG Diagnosis
BP Blood Pressure
HEENT head, eyes, ears, nose, throat
PMH Past Medical History
COPD Chronic Obstructive Pulmonary Disease
CBC Complete Blood Count
HIPAA Health Insurance Portability and Accountability
AMA American Medical Association
NPP Notice of privacy Practices
CAP Claims Assistance Professional
PHI Protected Health Information
A/R Accounts Receivable
POS Point of Service
HMO Health Maintenance Organization
PPO Preferred Provider Organization
Created by: SSchabow
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