99 definitions for Medical Office final exam
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Accellerator Key | is used to move ahead quickly; it allows the user to perform another function by choosing the appropriate key
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| Accept Assignment | checking yes in this box informs the insurance company that the physician/practice is agreeing to accept allowed amounts of the payer
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| Account Adjustment | any adjustment to the account (+/-)
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| Accounts Receivable | money coming into the practice
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| Admitting Diagnosis | the initial reason for admission to a hospital,even though that latter may be changed/updated
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| Aging Report | report that shows open insurance/patient account balances and how long they have been due (always shows 30+ days)
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| Allowed Charge/Allowed Amount | the maximum amount thqat the inusrance company will pay on a CPT/HCPCS
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| Alphanumeric | data entry consisting of #'s and letters
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| Appointment Schedule | A listing of patients to be seen at any given time
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| Assignment of Benefits | the patient signs an authorization form that allows the practice to receive reimbursement directly from the payer
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| Back-up | done daily to secure a copy of the info entered and saved on the computer
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| Batch | a group of claims sent together electronically
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| Billing Routine | is the way in which a specific office performs it's regular billing activities a such as transactions entry and monthly statement generation
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| Birthday Rule | A ruling that decides the primary insurance for dependents where there are two or more policies providing coverage
The rule states that the first birthday of the policy holders falling first in the calander year is the primary insurance
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| Bundled Code | A CPT that represents more than one individual procedure or service
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| Carrier | the name and address to which claims are sent
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| Case | In Medisoft, is a group of claims grouped together with one thing in common (ex. ins co, Dx, etc)
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| Charge Slip | Super Bill, Patient encounter form, A listing of the most commonly performed procedures used in the practice for billing. Also includes pt. name, ins/referral info. payment info, provider info
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| Chart Number | usually consists of 8 characters and is used internally by the practice to ID the patient in the software (Medent uses account numbers)
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| Charting | the provider's entries into the medical record
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| Checkbox | activating this will cause software to perform a specific function
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| Clearing House | this company is contracted to view electronic claims for completeness, then forward them to the carrier (They don't correct claims)
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| CMS1500 | is a standardized claim form used by MD offices
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| Comprehensive Insurance | combines both basic and major medical coverage
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| Consultation | is when a patient is seen by another provider to either confirm Dx or provide a 2nd opinion on a proposed Tx
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| Coordination of Benefits COB | a ruliing that allows for non-duplication of benefits where there is more than one insurance company providing coverage on a patient
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| Co-payment | a small amount of money paid at each visit for service (co-insurance)
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| CPT Codes | these represent the service or procedure rendered to the patient; Current Procedural Terminology
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| Credit | whether it is an adjustment or a payment it reduces the amount owed on the account
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| Daily Close/Daysheet | Daysheet/Daily close- is another term for the report that lists transactions to patient account and is done daily
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| Debit | will increase the amount of the account from what it originally was
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| Deductible | the portin that a patient must pay (out of pocket) before insurance will make payments
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| Dependents | people covered under the insured's contract and usually includes spouse, unmarried children
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| Diagnosis | provider's opinion of the condition/illness of patient
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| Disability | temporary or perminant, it is the time period during which a patient cannot perform usual activities
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| Edit Patient Screen | some softwares have a specific area to edit patient information
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| Elective Surgery | A procedure that is not a medical necessity
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| Electronic Claims Media | claims submitted electronically using a modem
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| Electronic Signature | is produced by making a selection in the software that allows for the providers endorsement to be produced on a given document
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| Encounter Form | SuperBill, Charge slip
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| Explanation of Benefits EOB | is a financial statement (usually accompanies payment) sent from the insurance company that lists payments, write-offs, amounts applied to deductables, patient responsibilities amounts and/or reason for non-payment
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| Faciilty | a provider of services (ex. hospitals, labs, etc.)
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| Fee Schedule | is a list of defined charges used for billing services or it is the list of CPT's and HCPCS's and their allowed amounts
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| Field | in a medical software package data is entered into a specific field (ie. name, address, ins. policy, policy holder, etc.)
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| Folder | a place where files are stored on the computer
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| General Ledger | a report of all financial details of the business which includes all expenses and incomes of the business
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| Global Fee | A fee charged for all care related to the man procedure (ex. patient would not be charged post-op visits for F-up
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| Global Period | A specific time period which the patient will receive treatment related to the primary procedure with no additional charges
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| Group | shows who the policy belongs to
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| Guarantor | the personnamed to insure payment of the patient's acount (not necessarily the patient)
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| Health Maintenance Organization HMO | is a type of managed care plan that has several types of providers that service patients in one facility
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| ICD-9 Codes | codes that represent the diagnosis(illness, condition, disease) of a patient; International Classification of Diseases, 9th revision, Clinical Modifications
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| Icon | a picture that you click on to select an option or use a particular application (shortcut to applications or part of the application)
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| Inpatient | a person receiving hospital care for 24+ hours
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| Insurance ID number | created by insurance companies, ID # is put on claims to identify patient and coverage for that patient
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| Insured/Insured Party | policy holder, subscriber, is the person who contracted with the insurance company
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| Main Menu | the start point in any software, helps to direct you through the software through a series of options
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| Malpractice | Improper/negligent medical care
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| Medicaid | a government sponsored insurance that provides coverage for lower income patients (sponsored by state, some federal)
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| Medicare | a government sponsored insurance that provides coverage for elderly, disabled, ESRF (sponsored by federal)
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| Modifier | a two digit code that alters the reason for billing a specific CPT/HCPCS. It further explains why/how something was done
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| Non-participating provider | provider who has not contracted with the insurance company does not have to accept their allowed charges meaning the patient can be billed for the difference between what the insurance company paid and what the doctor is billed
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| Open Items | on a patient account are CPT/HCPCS that have been fully paid or adjusted for
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| Outpatient | patient receiving hospital care for less than 24 hours
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| Participating provider | a provider who has contracted with an insurance company agreeing to it's fee schedule provisions
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| Password | to insure access only by authorized individuals and to limit certain areas of software this is issued
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| Patient Ledger | a financial record detailing all charges, payments and adjustments to a patient's account
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| Patient Registration Form | is filled out at the initial viasit of the patient and shoulc be updated periodically to insure correct address, phonem, insurance and/or dependents
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| PCP | primary care physician
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| Place of Service Code POS | represents the place at which services were rendered by provider (school, hospital, home, nursing home, etc)
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| Policy Holder | subscriber, insured/insured party
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| Posting an Account | applying payments, adjustments, and/or write-offs to an account
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| Premium | the amount a person pays to the company for coverage
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| Primary Insurance | The insuance billed first which usually pays the greater portion of the claim
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| Prior Authorization | Insurance companies require review of certain procedures before they will agree to consider payment. This is done by calling them before the procedure, providing related information and obtaining a reference # for this
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| Procedure Codes | same diference as CPT codes
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| Prognosis | Physician's prediction of future condition or outcome of the patient
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| Provider | the person rendering health care services
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| Receipts | given as proof of payment
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| Referral | is issued by the pcp to allow the patient to be seen by another physician/specialist for a certain reason. The insurance company can refuse coverage if this is not done
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| Responsible Party | Guarantor- ia the person who agrees to insure payment of the patient's account
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| Rider | an ammendment to an insurance policy may add additional coverage or impose restrictions
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| Right Click | allows you to use more options to become available quickly (brings up a menu with options)
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| Secondary Insurance | after a primary insurance has been responded and handled by the biller, the next step is to bill the secondary insurance (COB- coordination of benefits)
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| Specialist | a physician who has specialized training
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| Status Bar | located at the bottom of the screen and shows what the user is currently working on/in
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| Subscriber | policy holder, insured/insured party
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| Superbill | charge slip, encounter form
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| Support Files | lists of stored information on software for future or repeated use
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| Third Party Payer | also refered to as the carrier are billed for services done to the patient and reimburse the physician
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| Type of Service Code TOS | coincides with the procedure rendered such as medical or surgical
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| UB-04 Form | standardized claim form used by hospitals
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| Unbundle | to seperate into seperate CPT code two or more seperate codes
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| Units | (in a transaction entry) represents the number of times that a service/procedure was done on a given day
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| Voucher | Explanation of Benefits EOB In other businesses serves as an invoice
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| Walk-out Receipt | given to patients at checkout showing charges and payments for that day of service DOS
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| Worker's Compensation | Insurance which businesses have coverage for their employees to cover on the job injuries
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| Write-off | the difference between the amount charged (by the provider) and the allowed amount (amount allowed by the insurance company)
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