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Details

Medical Insurance Terms
medical office assistant training
25
Medical
Undergraduate 1
03/29/2012

Additional Medical Flashcards

 


 

Cards

Term
Exclusion
Definition
Time-dependent limitation of coverage
Term
Beneficiary
Definition
Person covered under policy terms.
Term
Coinsurance
Definition
Insurance carrier pays a percentage
Term
Deductible
Definition
Money insured pays for medical services
Term
Co pay/ment
Definition
payment collected at office visit
Term
Health maintenance organization (HMO)
Definition
Type of managed care
Term
Birthday Rule
Definition
Priority of medical care coverage under both parents.
Term
Explanation of benefits (EOB)
Definition
Summarizes reimbursements of services to you.
Term
Remittance advice
Definition
Summarizes all benefits paid to the provider
Term
Pre-authorization
Definition
Patient gets approval for procedure/visit
Term
Assignments of benefits
Definition
Payment sent to provider/patient
Term
Primary care provider (PCP)
Definition
First medical practitioner caring for patient.
Term
Managed care organization (MCO)
Definition
Assumes health care needs for an enrollee group
Term
Capitation
Definition
Fixed fee per enrollee
Term
Types of managed care organizations
Definition
Six models
Term
Exclusive provider organization (EPO)
Definition
Enrollee obtains service from provider network
Term
Integrated delivery systems (IDS)
Definition
Enrollee obtains service from affiliated group
Term
Health Maintenance organization (HMO)
Definition
Enrollee obtains services from fixed fee provider
Term
Point of service (POS) Plan
Definition
Enrollee has freedom to obtain an HMO/non HMO
Term
Preferred Provider Organization (PPO)
Definition
Enrollee obtains service from discount fee provider
Term
Triple option plan
Definition
Enrollee chooses traditional, HMO or PPO plans
Term
Medicare part A
Definition
Covers hospital stay, health care and hospice
Term
Benefit Period
Definition
Begins first day of hospital stay
Term
Medicare part B
Definition
Covers outpatient expenses
Term
Works compensation insurance
Definition
Medical/paycheck insurance for injured workers
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