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Details

MBIC Module 110
Insurance Billing Unit 2
50
Medical
Undergraduate 2
11/16/2011

Additional Medical Flashcards

 


 

Cards

Term
Accident
Definition
An unexpected happening, causing injury traceable to a definite time and place
Term
Adjudication
Definition
The final determination of the issues involving settlement of an insurance claim also known as a claim settlement
Term
By Report (BR)
Definition
A report must be submitted with the claim when the notation "BR" follows the procedure code description. This term is sometimes seen in worker's compensation fee schedules.
Term
Claims examiner
Definition
In industrial cases, a represetnative of the insurer who authorizes treatment and investigates, evaluates and negotiates the patients insurance claim and acts for the company in the settlement of claims; also known as claims adjuster, claims representative, and claims adminstrator.
Term
Compromise and Release
Definition
An agreement arrived at,whether in or out of court, for settling a worker's compensation case after the patient has been declared permanent and stationary.
Term
Deposition
Definition
The process of taking sworn testimony from a witness out of court. This is usually done by attorney.
Term
Ergonomic
Definition
Science and technology that seek to fit the anatomic and physical needs of the worker to the workplace.
Term
Extraterritorial
Definition
state laws effective outside the state by either specific provision or court decision.
Term
Federal Employees Compensation Act (FECA)
Definition
An act instituted in 1908 providing benefits for on-the-job injuries to all federal employees
Term
Fee schedule
Definition
a list of charges or established allowances for specific medical services and procedures
Term
Injury
Definition
any trauma or damage to a body part or disease sustained, arising out of, and in the course of employment, including injury to the artificial members and medical braces of all types.
Term
Insurance adjuster
Definition
an individual at the workers compensation insurance carrier overseeing an industrial case, authorizing diagnostic testing and medical treatment, and communicating with the physician out of any proceeds received on the case.
Term
Lien
Definition
a claim on the property of another as a security for debt.
Term
Medical Service Order
Definition
an authorization given to the physician, whether written or verbal to treat the injured or ill employee.
Term
Nondisability (ND) claim
Definition
on-the-job injury that requires medical care but does not result in loss of working time or income.
Term
Permanent Disability (PD)
Definition
an illness or injury expected to continue for the lifetime of the injured worker that prevents the person from performing the functions of his or her regular occupation, therefore impairing his or her earning capacity.
Term
Petition
Definition
a formal written request commonly used to indicate an appeal; also means any request for relief other than an application.
Term
Sub Rosa Films
Definition
videotapes made without the knowledge of the suject; used to investigate suspecious claims in workers compensation cases
Term
Temporary Disability (TD)
Definition
the recovery period after a work related injury during which the employee is unable to work and the condition has not stabilized; a schedule of benefits payable for the temporary disability.
Term
Third Party Liability
Definition
exists if an entity is liable to pay the medical cost for injury disease, or disability of a person hurt during the performance of his or her occupation and the injury is caused by the entity not connected with the employer.
Term
Thrid Party Subrogation
Definition
the legal process by which an insurance company seeks from a third part, who has caused a loss,recovery of the amount paid to the policyholder.
Term
Waiting Period
Definition
for disablity insurance the initial period of time when a disabled individual is not eligable to receive benefits even though unable to work; for workers compensation, the days that must elapse before workers compensation weekly benefits become payable.
Term
Work Hardening
Definition
individualized program of therapy using simulated or real job duties to build up strength and improve the worker's endurance to be able to work up to 8 hours a day.
Term
Workers' Compensation Appeals Board (WCAB)
Definition
the board that handles workers' compensation liens and appeals.
Term
Workers' Compensation (WC)Insurance
Definition
a contract that insures s person against on-the-job injury or illness. The employer pays the premium for his or her employees.
Term
conversion factor
Definition
the dollars and cents amount that is established for one unit as applie to the procedure or service rendered. The unit is the use to convert various procedures into fee-schedule payment amounts by multiplying the relative value unit by the conversion factor.
Term
endotracheal anesthesia
Definition
anesthesia is accomplishe by insertion of a tube into the nose or mouth, and passing the tube into the trachea for ventilation
Term
anesthesia
Definition
induction or administration of a drug to obtain a partial or complete loss of sensation
Term
general anesthesia
Definition
a state of unconsciousness that is accomplished by the use of a drug or combination of drugs administered intramuscularly, rectally, intravenously or by inhalation.
Term
Qualifying Circumstances
Definition
five digit CPT codes that describe situations or conditions that affect the administration of anesthesia.
Term
physical status modifier
Definition
modifying units in the Anesthia section of the CPT manual that describe a patient's condition at the time anestesia is administered
Term
-pnea
Definition
breathing
Term
-centesis
Definition
surgical puncture
Term
-plasty
Definition
surgical repair
Term
-stomy
Definition
new opening
Term
-oma
Definition
tumor, mass, fluid collection
Term
-lysis
Definition
destruction, seperation
Term
-tomy
Definition
incision
Term
-spasm
Definition
tension, spasm, contraction
Term
-rrhage
Definition
to burst forth
Term
-rrhaphy
Definition
suture
Term
-rrhexis
Definition
rupture
Term
-arche
Definition
beginning
Term
-cele
Definition
hernia, tumor, swelling
Term
-cyst
Definition
bladder, sac
Term
-graph
Definition
to write, record
Term
-malacia
Definition
softening
Term
-cyte
Definition
cell
Term
-kinesia
Definition
motion, movement
Term
-pathy
Definition
disease, emotion
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