Computers in the Medical Office Chapter 1 Sanderson
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| policyholder | a person or entity who buys an insurance plan; the insured
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| health plan | a plan, program, or organization that provides health benefits
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| premium | the periodic amount of money the insured pays to a health plan for insurance coverage
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| payer | private or government organization that insures or pays for health care on behalf of beneficiaries
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| fee-for-service | health plan that repays the policyholder for covered medical expenses
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| deductible | amount due before benefits start
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| coinsurance | percentage of charges that an insured person must pay for health care services after payment of the deductible amount
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| managed care | a type of insurance in which the carrier is responsible for both the financing and delivery of health care
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| preferred provider organization (PPO) | managed care network ofhealth care providers who agree to perform services for plan members at discounted fees
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| health maintenance organization (HMO) | a managed health care system in which providers agree to offer health care to the organization's members for fixed payments
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| capitation | payment to a provider that covers each plan member's health care services for a certain period of time
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| copayment | a fixed fee paid by the patient at the time of an office visit
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| consumer-driven health plan (CDHP) | a type of managed care with a high deductible, low premium insurance plan combined with pretax savings account to cover out-of-pocket medical expenses
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| patient information form | a form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim
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| documentation | a record of health care encounters between physician and the patient
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| medical record | chronological record of a patient's medical history and care
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| diagnosis | physician's opinion of the nature of the patient's illness or injury
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| procedure | medical treatment provided by a physician or other health care provider
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| coding | the process of translating a description of a diagnosis or procedure into a standardized code
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| diagnosis code | standardized value that represents a patient's illness, signs, symptoms
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| procedure code | code that identifies a medical service
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| modifier | two-digit character appended to a CPT code to report special circumstances
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| encounter form | list of the procedures and charges for a patient's visit
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| electronic health record (EHR) | computerized lifelong health care record for an individual that incorporates data from providers who treat the individual
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| practice management program (PMP) | software program that automates many of the administrative and financial tasks in a medical practice
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| medical coder | person who analyzes and codes patient diagnoses, procedures and symptoms
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| medical necessity | treatment provided by physician for the purpose of preventing, diagnosing, or treating an illness, injury or symptoms; generally accepted medical practice
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| adjudication | series of steps that determine whether a claim should be paid
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| remittance advice (RA) | an explanation of benefits transmitted electronically by a payor to a provider
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| explanation of benefits (EOB) | paper document from a payer that shows how the amount of a benefit was determined
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| statement | a list of all services performed for a patient, along with the charges for each service
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| accounting cycle | the flow of financial transactions in a business
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| accounts receivable (AR) | money that is flowing into a business
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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.
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.
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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