Term
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Definition
| a person or entity who buys an insurance plan; the insured |
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Term
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Definition
| a plan, program, or organization that provides health benefits |
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Term
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Definition
| the periodic amount of money the insured pays to a health plan for insurance coverage |
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Term
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Definition
| private or government organization that insures or pays for health care on behalf of the beneficiaries |
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Term
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Definition
| health plan that repays the policyholder for covered medical expenses |
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Term
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Definition
| amount due before benefits start |
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Term
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Definition
| percentage of charges that an insured person must pay for health care services after payment of the deductible amount |
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Term
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Definition
| a type of insurance in which carrier is responsible for both the financing and the delivery of health care |
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Term
| preferred provider organization (PPO) |
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Definition
| managed care network of health care providers who agree to preform services for plan members at discounted fees |
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Term
| health maintenance organization (HMO) |
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Definition
| a managed health care system in which providers agree to offer health care to the organizations members for fixed payments(regular intervals, monthly) |
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Term
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Definition
| payment to a provider that covers each plan members health care services for a certain period of time (the fixed payment for HMO) |
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Term
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Definition
| a fixed fee paid by the patient at the time of an office visit (most HMO) |
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Term
| customer-driven health plan (CDHP) |
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Definition
| a type of managed care in which a high deductible, low premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses |
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Term
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Definition
| a form that includes a patients personal, employment, and insurance data needed to complete an insurance claim |
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Term
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Definition
| a record of health care encounters between the physician and the patient created by the provider |
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Term
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Definition
| a chronological record of a patients medical history and care that includes information that the patient provides, as well as the physicians assessment, diagnosis, and treatment plan |
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Term
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Definition
| physicians opinion of the nature of the patients illness or injury |
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Term
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Definition
| medical treatment provided by a physician or other health care provider |
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Term
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Definition
| the process of translating a description of a diagnosis or procedure into a standardized code |
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Term
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Definition
| a standardized value that represents a patients illness, signs, and symptoms |
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Term
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Definition
| a code that identifies a medical service |
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Term
| Current Procedural Terminology (CPT) |
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Definition
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Term
| International Classification of Diseases (ICD) |
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Definition
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Term
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Definition
| a two digit character that is appended to a CPT code to report special circumstances involved with a procedure or service |
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Term
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Definition
| a list of the procedures and changes for a patients visit |
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Term
| electronic health record (EHR) |
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Definition
| a computerized lifelong health care record for an individual that incorporates data from providers who treat the individual |
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Term
| practice management program (PMP) |
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Definition
| a software program that automates many of the administrative and financial tasks in a medical practice |
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Term
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Definition
| a person who analyzes and codes patient diagnoses, procedures, and symptoms |
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Term
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Definition
| treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or it's symptoms in a manner that is appropriate and is provided in accordance with generally accepted standards of medical practice |
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Term
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Definition
| series of steps that determine whether a claim should be paid |
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Term
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Definition
| an explanation of benefits transmitted electronically by a payer to a provider |
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Term
| explanation of benefits (EOB) |
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Definition
| paper document from a payer that shows how the amount of a benefit was determined |
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Term
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Definition
| a list of all services performed for a patient, along with the charges for each service |
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Term
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Definition
| the flow of financial transactions in a business |
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Term
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Definition
| monies that are flowing into a business |
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