medical billing and coding chapter 2
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| coinsurance | predetermined percentage the patient is responsible to pay for covered services.
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| copayment | fixed amount that a patient pays for specific services.
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| covered benefits | services outlined in the policy that re payable by the health plan.
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| deductible | amount patient must pay before the insurance will begin to pay for covered benefits.
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| HMO | health maintenance organization. contracted providers that agree to the payment contract for its members.
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| noncovered services | services that are not payable by the health plan.
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| out-of-network | a provider who does not have signed agreement with an insurance plan.
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| policyholder | the individual who signs a contract with a health insurance company
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| PPO | preferred provider organization. providers join networks and are consider preferred when a patient seeks treatment.
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| ICD-10-CM | international classification of disease, 10th revision, clinical modification.
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| Medical record | contains facts, findings, and observations about a patient’s health.
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| Malpractice | a failure to use professional skill when
giving medical services that results in injury or harm.
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| EHR electronic health record | are computerized, lifelong healthcare records with data from all sources.
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| Revenue Cycle with Medical Documentation | Both billing information and clinical information are
collected from the patient and documented.
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| HIPPA | protect private health information, ensure coverage, uncover fraud and abuse, and create industry standards
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| Clearinghouse | Company that converts nonstandard transactions into
standard transactions and transmits the data to health plans
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| who does a patients medical record belong to? | Medical record belongs to the provider who created it
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| Breach | impermissible use or disclosure of hippa that could pose significant risk to the affected person.
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| Fraud | intentional deceptive act to obtain a
benefit by taking advantage of another person
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| PHI | individually identifiable health information transmitted or maintained by electronic media
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| Premium | the amount a patient pays each amount to receive service.
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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