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36 Cards in this Set

  • Front
  • Back
Assignment
authorization to pay benefits (the person that receives payment)
Beneficiary
person eligible to receive benefits
CHAMPUS
covers spouses and dependents of person on active military dute
Claim
demand for payment of covered medical expenses
Coordination of Benefits
a provision use by an insurance company to avoid duplicating payments
Copayment
when insured pays a part of the specified portion towards the services rendered
Coverage
something that covers; as an insurance policy or protective plan
CPT
current procedural terminology 4th edition (insurance codes)
Deductible
annual out-of-pocket expense paid before coverage starts each year
Dependents
included under insurance policy, usually spouse and/or children
Disability
any physical, mental, or social limitation of a person
DRG
diagnostic related group (determines how long a patient's hospital stay is)
Eligibility
worthy or being chosen, qualified to be chosen
EOB
explanation of benefits (breakdown and explain payments on a claim
EOMB
explanation of medical benefits
Estimate
to judge tentatively or approximately the value, worth
Exclusions
exceptions of diseases or disorders not reimbursable by insurance company
Existing condition
disease or disorder that existed within a specfied time period before acquiring insurance
HCPCS
health care procedural coding system (developed by federal HCFA for medicare and medicaid programs
HMO
health maintenance organization (central health care)
ICD-9-CM
international classification of disease, 9th edition, clinical modification (speed processing and payment)
IPA
independent practice association or independent physician association (follows the HMO philosophy)
Lapse
termination of coverage for non payment of premiums
Medicaid
insures persons on public assistance
Medicare
medical coverage designed for the elderly over 65 years of age
PPO
preferred provider organization (non HMO plan)
Premium
periodic payment made by policy holder to insurance company
Probationary period
the state or a time period of being subject to probation
Reciprocity
the quality or state of being reciprocal, mutual dependence, action, or influence (2/3=3/2)
RVS
relative value scale/study or schedule (used to determine how much will be billed to workers' compensation
HIC
health insurance claim
Provider
person who provides medical care
Subscriber
insured or policyholder
UCR
usual, customary, reasonable
Void
negate or invalidate
Workers' Compensation
covers job related illness or injuries