Term
| PMPM--CAPITATATED RATE--SCHEDULE OF BENEFITS |
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Term
| IN "FEE FOR SERVICE"-3RD PARTY PAYERS MAKES PAYMENT |
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Term
| WRITEN INSURANCE CONTRACT- POLICYHOLDER & INSURANCE PROVIDES |
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Term
| iN "INDEMNITY PLAN" WHAT MUST BE MET? |
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Definition
| PREMIUM, DEDUCTIBLE, COINSURANCE |
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Term
| TO BE COVERED A PT WHO ENROLLS IN AN HMO |
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Definition
| MUST ONLY USE HMO NETWORK PROVIDERS |
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Term
| UNDER HIPAA--CLEARINGHOUSES, HOSPITALS, SNF-- ARE CALLED? |
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Term
| UNDER HIPAA IF THEY HIRE CPA, LAWYER, S/N COMPANY THEY ARE CALLED |
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Term
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Definition
| establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity.,requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information |
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Term
| THE MOST IMPORTANT STRATEGY IN HIPAA |
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Definition
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Term
| IN COORDINATION OF BENEFITS WHAT % CAN BE PAID AS BENEFITS |
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Term
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Definition
| ENTRY INTO PATIENTS ACCOUNT |
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Term
| ASSIGN BENEFITS TO PHYSICIANS |
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Term
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Definition
| POLICYHOLDER, SPONSOR, GUARANTOR |
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Term
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Definition
| ANNUAL EXAM, WELL BABY VISIT, ONGOING TREATMENT |
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Term
| E CODE=EXTERNAL CAUSE (E CODE CANNOT STAND ALONE) |
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Term
| CONDITION THAT ARISES BECAUSE OF PAST HISTORY ILLNESS |
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Term
| AUDIT PERFORMED INTERNALLY BEFORE CLAIMS SENT OUT |
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Term
| EXTERNAL AUDIT THAT PERFORMED BY PAYER |
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Term
| In Medical practice who is responsible for everything in office |
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Term
| WRITES REGULATION GUIDELINES FOR E/M CODES |
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Term
| 3 MAIN PAYMENTS METHODS USED TO PAY |
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Definition
| CAPITATION, ALLOWED CHARGES , CONTRACTED FEE SCHEDULE |
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Term
| WHAT IS PROFESSIONAL COURTESY |
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Definition
| WHEN PHYSICIAN AND DISCOUNT/FREE SERVICES |
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Term
| the physician who actually provides services |
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Term
| FEDERAL HEALTH EMPLOYEES PROGRAM |
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Term
| CAPITATED PLAN ELIGIBILITY |
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Term
| STOP-LOSS PROVISION---PROTECTION AGAINST |
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Definition
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Term
| AMOUNT OF TIME EMPLOYER MUST WAIT TO ENROLL U CALLED |
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Term
| IF POLICY STATES AMOUNT THAT MUST BE PAID |
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Definition
| IS A COMPANY THAT WORKS FOR HEALTH PLAN & SET DISCOUNT |
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Term
| MEDICARE NON PARTICIPATING |
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Definition
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Term
| PROGRAM THAT PROVIDES PHYSICIAN INCENTIVES ON WHO LOG PATIENT CARE PERFORMANCE |
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Definition
| PHYSICIAN QUALITY REPORTING INITIATIVE |
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Term
| IN MEDICARE ALL LAB WORK REGULATED(PAID) BY |
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Term
| MEDICAID PROGRAM IS JOINTLY FUNDED |
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Term
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Term
| 3RD PARTY PAYER DECISION TO PAY |
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Term
| CLAIM REMOVED FROM AUTOMATED SYSTEM |
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Term
| WHEN CLAIM IS PULLED FOR MANUAL REVIEW THEY NEED |
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Term
| NON PARTICIPATING CHECK GOES TO |
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Term
| PaTIENT IN ICU (requiring extenuative care) different physician |
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| PAY IT, DENY OR PARTIAL PAY |
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Definition
| COORDINATES BENEFITS FOR OTHER INSURANCE |
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Term
| IN AUTO ACCIDENT WHO PAYS 1ST |
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Term
| 1ST STEP FOR MEDICARE APPEAL |
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Definition
| REVIEW BY DEPT. OF APPEAL |
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