Computer Software Applications Chapter 4

Front 1

patient portal

Back 1

secure website that enables communication between patients and health care providers fir tasks such as scheduling, completing registration forms and making payments

Front 2

Open hours

Back 2

places like urgent care or walk in that patients cannot make an appointment. they are sent on a first come first serve basis.

Front 3

stream scheduling

Back 3

designed to give the provider a steady stream of patients throughout the day at regular blocked off intervals. usually 15 minutes

Front 4

double booking

Back 4

2 or more patients are scheduled in the same time slot. The provider speaks with one patient as the CM records the vitals signs of the other patient

Front 5

wave scheduling

Back 5

patients are scheduled in waves at the beginning of each hour with the rest of the hour left open.

Front 6

new patient (NP)

Back 6

a patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past 3 years

Front 7

established patient (EP)

Back 7

patient who has received professional services from provider ( or another provider with the same specialty in the same practice) within the past 3 years

Front 8

pre registration

Back 8

The process of gathering basic contact, insurance and reason for visit information before a new patient comes into the office for an encounter.

Front 9

gathering insurance information

Back 9

name of plan, member ID number, name of policy holder, type of plan, copay and name of referring physician

Front 10

participating provider (PAR)

Back 10

a provider who agrees to provide medical services to a payers policyholder according to the terms of the plans contract

Front 11

nonparticipating provider (nonPAR)

Back 11

a provider who chooses not to join a particular government or other health plan

Front 12

medical insurance

Back 12

financial plan that covers the cost of hospital and medical care

Front 13

policyholder

Back 13

person who buys an insurance plan, the insured, subscriber or guarantor

Front 14

Health plan

Back 14

am individual or group plan that either provides or pays for the cost of medical care. includes group health plans, health insurance issuers, health maintenance organization, Medicare part A and part B, medicaid, TRICare, and other government and non government plans

Front 15

payer

Back 15

Health plan or program

Front 16

premium

Back 16

money the insured pays to a health plan for a health care policy. usually paid monthly

Front 17

benefits

Back 17

The amount of money a health plan pays for services covered in an insurance policy

Front 18

major types of third - party payers

Back 18

private payers, self funded health plans and government sponsored health care programs

Front 19

government health care programs

Back 19

medicare- for people over 6 and those who are disabled.
medicaid- covers low income people
TRICARE- covers active duty members of uniformed services and their spouses, children and other dependents. retired military personnel and their dependents. and family and children of deceased serviceman
CHAMPVA ( civilian health and medical program of the department of Veterans affairs) covers veterans with permanent disabilities and their dependents. Also covers surviving spouses and children.

Front 20

schedule of benefits

Back 20

list of the medical expenses that a health care plan covers

Front 21

provider

Back 21

person or entity that supplies medical or health services and bills for or is paid for the services in the normal course of business. may be a professional member of the health care team such as a physician or a facility such as a hospital or skilled nursing home

Front 22

covered services

Back 22

medical procedures and treatments that are included as benefits under an insured's health plan

Front 23

preventive medical services

Back 23

care plan that is provided to keep patients healthy or to prevent illnes. such as routine checkups and screening tests

Front 24

Non covered services

Back 24

medical procedures that are not included in a patient's benefits

Front 25

preexisting condition

Back 25

illness or disorder of a beneficiary that existed before the effective date of insurance coverage

Front 26

indemnity plan

Back 26

type of medical insurance that reimburses a policyholder for medical services under the terms of its schedule of benefits

Front 27

conditions for payment. (4)

Back 27

1) the medical charge must be for medically necessary services that are covered.
2) the patients payment of the premium.
3) deductible must be paid
4) any coinsurance
charge- deductible- coinsurance- health plan payment

Front 28

deductible

Back 28

an amount that am insured person must pay usually on am annual basis for health care services before a health plan payment begins

Front 29

coinsurance

Back 29

The portion of charges that an insured person must pay for health care services after payment of the deductible amount usually stated as a percentage

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out - of - pocket

Back 30

expenses the insured must pay before benefits begin

Front 31

fee - for - services

Back 31

Health plan that repays the policyholder for covered medical expenses

Front 32

managed care

Back 32

system that combines the financing and delivery of appropriate cost effective health care services to its members

Front 33

capitation

Back 33

a prepayment covering provider's services for a plan member for a specified period

Front 34

Most common managed care plans

Back 34

HMO (health maintenance organization)
POS (point of service)
PPO (preferred provider organization)
CDHP (consumer driven pkans)

Front 35

participation as a provider

Back 35

means that a provider has contracted with a health plan to provide services to the plans beneficiaries.

Front 36

out of network

Back 36

a provider that does not have a participation agreement with a plan. using an out of pocket network provider is more expensive

Front 37

pre authorization

Back 37

prior authorization from a payer for services to be provided. If not pre authorization it's not covered

Front 38

Co payment ( copay)

Back 38

an amount that a health plan requires a beneficiary to pay at the time of service for each encounter

Front 39

referral

Back 39

transfer of patient care from one physician to another

Front 40

Open access plans

Back 40

many HMO's have switched from gatekeeper plans that require referrals to all specialist to plans that permit members to visit any specialist in the network.

Front 41

online eligibility services

Back 41

provides a computer network got instant communication of clinical, financial and administrative data with the major insurance payers.

Front 42

referral number

Back 42

authorized number given by a referring physician to the referred physician

Front 43

provider selection box

Back 43

a selection box that determines which providers schedule is displayed in the providers daily schedule

Front 44

providers daily schedule

Back 44

a listing of times slots for a particular day for a specific provider that corresponds to the date selected on the calendar

Front 45

Office hours calendar

Back 45

an interactive calendar that is used to select or change dates in office hours

Front 46

Office hours patient information

Back 46

The area of the office hours window that displays information about the patient who is selected in the providers daily schedule

Front 47

Office hours break

Back 47

a block of time when a physician is unavailable fir appointments with patients