Module C - Unit 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Assignment of Benefits | patient's written authorization giving the insurance company the right to pay the physician directly for billed charges.
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| Bankruptcy | a condition in which a patient is protected by the court and all collection attempts muct cease.
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| Collections |
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| Copayment | amount specified by an insurance plan that the patient must pay before the plan pays (commonly used in managed care plans)
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| CPT | Current Procedure Terminology
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| Crossover Claim | patient is eligible for both Medicare and Medicaid (also called Medi/Medi)
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| Cycle Billing | type of billing divided into groups
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| Deductible | amount of eligible charges each patient must pay each calendar year before the plan begins to pay benefits.
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| Delinquent | account past due
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| Fee Schedule | schedule of the amount paid by a specific insurance company for each procedure or service. Amounts are determined by a claims administrator and applied to claims subject to the fee schedule of a provider's managed care contract.
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| Hospice | patient-centered interdisciplinary program of care and supportive services for terminally ill patients and their families.
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| HCFA | Healthcare Financing Administration
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| HMO (Health Maintenance Organization) | type of managed care plan in which a range of health care services are made available to plan members for a predetermined fee (the capitation rate) per member, by a limited group of providers (such as physicians and hospitals).
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| Inpatient | patient who remains within the medical facility at least overnight for care and/or treatment.
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| Insured | individual who is covered under an insurance plan.
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| Outpatient | patient undergoing medical treatment which does not necessitate staying overnight in the facility. Also referred to as ambulatory or a "23 hour hold."
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| Medicare | health insurance for the elderly provided by the United States government.
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| Medicaid | designed for the medically indigent, or persons without funds, comes from state funds, with some money to offset costs.
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| Preauthorization | a requirement of Medicare and insurance companies to obtain prior approval for surgery and other procedures in order to receive reimbursement.
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| PCP | Primary Care Physician or Primary Care Provider
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| PPO | Preferred Provider Organization
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| Premium | amount paid for insurance coverage.
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| Statute | refers to time a legal collections suit may be brought against debtor
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| Subscriber | person who holds a health benefit plan/contract. This plan, contract, or policy may include other family members.
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| UCR | Usual, Customary, Reasonable Method
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| Acquired Immune Deficiency Syndromes (AIDS) | series of infections that occur as a result of infection by the human immunodeficiency virus (HIV) wich causes the immune system to break down.
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| Ambulatory Care | referes to health service facility which provides health care to individuals who are not hospitalized.
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| Diagnostic Related Groups (DRGs) | designations used to identify reimbursement per condition in a hospital. Used for Medicare patients.
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| Legionnaires' Disease | severe, sometimes fatal disease, caused by a baccilus that is inhaled. First occurence was at the Legionnaire's convention in 1976.
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| Medical Privileges | ability of a physician to admit patients and practice medicine at a particular hospital.
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| Primary Care | basic or general health care a person receives for common illnesses. A primary care physician is the one to whom the patient and/or family will go to seek most medical care.
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| Proprietary Hospital | a hospital that operates on a for-profit basis.
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| Benefit Period | period of time for which payments for Medicare inpatient hospital benefits are available.
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| Claim | written and documented request for reimbursement of an eligible expense under an insurance plan.
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| Coding | Transferring narrative description of diseases and procedures into a number
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| Coinsurance | a cost-sharing provision requires the insured to assume a portion of the cost of covered services.
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| Indemnity Schedule | list of determined amounts to be paid for specific services by the insurance carrier on behalf of the insured.
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| Medically Indigent | person without insurance coverage and with no funds.
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| Nonparticipating Provider | provider who decides not to accept an allowable charge as the full fee for care.
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| Participating Provider | one who accepts assignment and is paid directly by the plan.
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| Prepaid Plan | a group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-service or capitated basis (also called managed care plan).
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| Rider | a written exception to an insurance contract, expanding, decreasing, or modifying coverage of an insurance policy.
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