4010 1Terms and Abbreviations
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| Ethics | standards of conduct generally accepted as a moral guide for behavior by which an insurance billing or coding specialist may determine the appropriateness of his or her conduct in a relationship with the patients, the physician, co-workers, the government
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| Etiquette | Customs, rules of conduct, courtesy, and manners of the medical profession
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| Capitation | a system of payment used by managed care plans in which physicians and hospitals are paid/ fixed per capita amount for each patient enrolled over a stated period of time regardless of the type and number of services provided
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| Expressed Contract | A verbal or written agreement
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| Respondent Superior | "Let the Master answer" refers to a physician's liability in certain cases for wrongful acts of his assistant(s) or employee(s)
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| Accounts Receivable Management | The organization and administration of coding and billing in a medical practice
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| Guarantor | An individual who promises to pay the medical by signing a form agreeing to pay or who accepts treatment, which constitutes an expressed promise.
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| Implied Contract | Not manifested by direct words but implied or deduced from the circumstances
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| Medicaid | A federally aided state operated and administered program that provides medical benefits for certain low income families
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| Medicare | A nationwide health insurance program for those who are 65 years old and older
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| Medicaid/Medicare(Medi/Medi) | Refers to an individual who has both Medicaid and Medicare benefits
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| Principle Diagnosis | A condition established after study that is chiefly responsible for the admission of the patient into the hospital
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| Discharge Summary | various services provided that prepare the patient for discharge from the inpatient facility
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| Fraud | An intentional misrepresentation of the facts to deceive or mislead another
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| Medical Necessity | The performance of services and procedures that are consistent with a diagnosis in accordance with standards of good medical practice performed at the proper level and provided in the most appropriate setting
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| DIAG | Diagnosis
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| BP | Blood Pressure
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| HEENT | head, eyes, ears, nose, throat
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| PMH | Past Medical History
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| COPD | Chronic Obstructive Pulmonary Disease
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| CBC | Complete Blood Count
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| HIPAA | Health Insurance Portability and Accountability
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| AMA | American Medical Association
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| NPP | Notice of privacy Practices
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| CAP | Claims Assistance Professional
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| PHI | Protected Health Information
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| A/R | Accounts Receivable
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| POS | Point of Service
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| HMO | Health Maintenance Organization
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| PPO | Preferred Provider Organization
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