Question | Answer |
Release of Information | Legal document that authorizes info to be released to a medical insurance carrier |
IPA | Independent practice association |
HMO | Health maintenance organization |
Primary Diagnosis | A patients major health problem |
Attending Physician | The physician in charge of patient care |
TAR | Treatment authorization request |
Provisional Diagnosis | A tempo diagnosis made prior to receiving actual test results |
Workers Compensation | Insurance to cover work related injuries and illness |
EMR | Electronic medical record |
TPO | Treatment payment operations |
Pre-existing Condition | Diagnosis before insurance policy was written |
CMS | Centers for medicare and medicaid services |
TriCare | Provides military personnel with health care |
PPO | Preferred provider organization |
Carrier | A company that assumes the risk of an insurance policy |
Birthday Rule | When covered under two insurances, use the insurance policy of the policy holder who's birthday comes first. |
COB | Coordination of Benefits |
Group Policy | Policy that covers several people on a master contract |
Emancipated Minor | Person who isnt 18 but has the same legal rights as an adult |
Balance Billing | Billing the patient for the amount not covered by insurance |
Medical Necessity | The process of establishing the medical need for medical services |
Write off | Difference between a full fee and an allowed fee |
Disability | Lack of ability to perform in a range considered normal |
Allowed charge | Max amount insurance company pays for service |
Managed Care | A health care system whose goals are to provide cost effective quality care. |
Co-payment | The portion of a service fee that the patient must pay |
Delinquent Claim | Claim with payment overdue |
Walk out statement | Printed form with estimated charges that patient takes with them |
Gate Keeper | Term given to primary care physician for coordinating the patients care |
Accident | An unexpected happening that may result in injury, loss, or damage. |
Grievance Procedure | a provision for resolving issues that may come up later |
Lapse | Termination of insurance coverage for lack of insurance payment |
Probationary Period | Waiting period when certain pre existing conditions are excluded |
Waiver | a document that shows a person voluntarily gives up a right, claim or privilege |
Disability income insurance | Provides income to those who are injured and unable to work |