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MOD 4010 WEEK 1

TERMINOLOGY

QuestionAnswer
ETHICS STANDARDS OF CONDUCT GENERALLY ACCEPTED AS A MORAL GUIDE FOR BEHAVIOR BY WHICH AN INSURANCE BILLING OR CODING SPECIALIST MAY DETEMINE THE APPROPRIATENESS OF HIS OR HER CONDUCT IN A RELATIONSHIP WITH PATIENTS, THE PHYSICIAN, CO-WORKERS, THE GOVERNMENT, AND
ETIQUETTE CUSTUMS, RULES OF CONDUCT, COURTESY, AND MANNER OF THE MEDICAL PROFESSION
CAPITATION A SYSTEM OF PAYMENT USED BY THE MANAGED CARE PLANS IN WHICH PHYSICIANS AND HOSPITALS ARE PAID A FIXED PER CAPITA AMOUNT
EXPRESSED CONTRACT A VERBAL OR WRITTEN AGREEMENT
RESPONDENT SUPERIOR "LET THE MASTER ANSWER" REFERS TO THE PHYSICIANS LIABILITY IN CERTAIN CASES FOR THE WRONGFUL ACTS OF HIS OR HER ASSISTANT OR EMPLOYEES
ACCOUNTS RECEIVABLE MANAGEMENT THE ORGANIZATION AND ADMINISTRATION OF CODING AND BILLING IN A MEDICAL PRACTICE
GUARANTOR AN INDIVIDUAL WHO PROMISES TO PAY THE MEDICAL BILL BY SIGNING A FORM AGREEING TO PAY OR WHO ACCEPTS TREATMENT, WHICH CONSTITUTES AN EXPRESSED PROMISE
IMPLIED CONTRACT A CONTRACT BETWEEN PHYSICIAN AND PATIENT NOT MANIFESTED BY DIRECT WORDS BUT IMPLIED OR DEDUCTED FROM THE CIRCUMSTANCE, GENERAL LANGUAGE, OR CONDUCT OF THE PATIENT
MEDICAID A FEDERALLY AIDED, STATE-OPERATED AND STATE ADMINISTERED PROGRAM THAT PROVIDES MEDICAL BENEFITS FOR CERTAIN LOW INCOME PERSONS IN NEED OF HEALTH AND MEDICAL CARE
MEDICARE A NATIONWIDE HEALTH INSURANCE PROGRAM FOR PERSONS AGE 65 AND OLDER
MEDICARE/MEDICAID REFERS TO AN INDIVIDUAL WHO RECEIVES MEDICAL OR DISABILITY BENEFITS FROM BOTH MEDICARE AND MEDICAID PROGRAMS
PRINCIPLE DIAGNOSIS A CONDITION ESTABLISHED AFTER STUDY THAT IS CHEIFLY RESPONSIBLE FOR THE ADMISSION OF THE PATIENT TO 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 CONSISTANT WITH THE DIAGNOSIS IN ACCORDANCE WITH STANDARDS OF GOOD MEDICAL PRACTICE,PERFORMED AT THE PROPER LEVEL, AND PROVIDED IN THE MOST APPROPRIATE SETTING
Created by: reginacamarena