Shared Flashcard Set

Details

Insurance Billing and Coding
Chapter 15 Comprehensive MA Pearson
37
Insurance
Beginner
10/24/2016

Additional Insurance Flashcards

 


 

Cards

Term
Advance Beneficiary Notice (ABN)
Definition
Notice to a patient that services may be denied by Medicare and that the patient would be obligated to pay
Term
Allowed Amount
Definition
The amount insurance companies consider to be an appropriate fee for a given service
Term
Beneficiary
Definition
A person who is eligible for coverage by government health policies
Term
Centers for Medicare and Medicaid Services (CMS)
Definition
The federal agency that administers the Medicare program and works with state governments to administer Medicare/Medicaid programs
Term
Clean claim
Definition
Health insurance claim form that has been completed correctly without any errors
Term
CMS-1500
Definition
Most common health insurance claim form used to file claims for physicians services
Term
Coinsurance
Definition
a fixed percentage of charges the patient must pay under a given insurance plan ex: 80/20,70/30
Term
Coordination of Benefits
Definition
procedures to prevent duplication of payments by more than one insurance carrier
Term
Current Procedural Terminology (CPT)
Definition
codes that identify the services that were provided (office visit, consultation, surgeries)
Term
Deductible
Definition
Amount that patients need to pay each calendar year before the insurance plan starts to pay benefits
Term
Dependent
Definition
family member on a health plan
Term
Elective procedure
Definition
medical procedure that is non-emergent but may benefit the patient
Term
Fee schedule
Definition
schedule of fees for each procedure or service that physicians office's provide
Term
Fee-for-Service
Definition
set fees for services established by a health care provider and paid for by the patient
Term
Gatekeeper
Definition
primary care provider
Term
Health Maintenance Organization
Definition
type of managed care plan that requires patients to choose a pcp
Term
Managed Care Organization
Definition
a form of health insurance intended to reduce costs, broken down into 3 major classifications of health insurance
Term
Medicaid
Definition
insurance designed for low income individuals
Term
Medical necessity
Definition
The process of establishing a medical need for something
Term
Medicare
Definition
Insurance for people age 65 and up, disabled or patients who have ESRD
Term
Medicare Part A
Definition
hospital insurance includes inpatient, home care, hospice and inpatient psych services
Term
Medicare Part B
Definition
Medical insurance, doctors visits, outpatient facilities like physical therapy and lab testing
Term
Medicare Part C
Definition
Managed care or advantage plan
Term
Medicare Part D
Definition
Prescription drug coverage
Term
Tricare
Definition
Insurance for active duty and retired military personnel and their families
Term
CHAMPVA
Definition
Insurance for veterans with service related disabilities
Term
Workers Compensation
Definition
Insurance that covers employees injured in the workplace or off-site while conducting company business or suffering a workplace-related illness
Term
Medigap
Definition
insurance that fills the gap in Medicare
Term
National Provider Identifier
Definition
Ten-digit identification number assigned to health care providers by the Centers for Medicare and Medicaid Services
Term
Point of Service
Definition
Type of managed care organization that allows you to choose between an HMO and a PPO
Term
Primary Care Provider
Definition
A provider who refers patients to other providers for more specialized care and oversees and manages all aspects of patients health care
Term
Preauthorization
Definition
Requirement to obtain prior approval before surgery and other procedures including medications
Term
Premium
Definition
Monthly payment for health insurance
Term
Primary Policy
Definition
The insurance policy billed first for any health care services
Term
Secondary Policy
Definition
The insurance billed for the costs that are not covered by the primary payer
Term
Copayment
Definition
The amount that patient pays that is determined by the insurance at the time of the visit
Term
Participating Provider
Definition
A provider who has a contractual agreement with an insurance plan to render care to eligible beneficiaries and then bill the insurance carrier directly
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