Insurance Terminology For Medical Administrative Assistant Students

Front 1

Assignment

Back 1

authorization to pay benefits (the person that receives payment)

Front 2

Beneficiary

Back 2

person eligible to receive benefits

Front 3

CHAMPUS

Back 3

covers spouses and dependents of person on active military dute

Front 4

Claim

Back 4

demand for payment of covered medical expenses

Front 5

Coordination of Benefits

Back 5

a provision use by an insurance company to avoid duplicating payments

Front 6

Copayment

Back 6

when insured pays a part of the specified portion towards the services rendered

Front 7

Coverage

Back 7

something that covers; as an insurance policy or protective plan

Front 8

CPT

Back 8

current procedural terminology 4th edition (insurance codes)

Front 9

Deductible

Back 9

annual out-of-pocket expense paid before coverage starts each year

Front 10

Dependents

Back 10

included under insurance policy, usually spouse and/or children

Front 11

Disability

Back 11

any physical, mental, or social limitation of a person

Front 12

DRG

Back 12

diagnostic related group (determines how long a patient's hospital stay is)

Front 13

Eligibility

Back 13

worthy or being chosen, qualified to be chosen

Front 14

EOB

Back 14

explanation of benefits (breakdown and explain payments on a claim

Front 15

EOMB

Back 15

explanation of medical benefits

Front 16

Estimate

Back 16

to judge tentatively or approximately the value, worth

Front 17

Exclusions

Back 17

exceptions of diseases or disorders not reimbursable by insurance company

Front 18

Existing condition

Back 18

disease or disorder that existed within a specfied time period before acquiring insurance

Front 19

HCPCS

Back 19

health care procedural coding system (developed by federal HCFA for medicare and medicaid programs

Front 20

HMO

Back 20

health maintenance organization (central health care)

Front 21

ICD-9-CM

Back 21

international classification of disease, 9th edition, clinical modification (speed processing and payment)

Front 22

IPA

Back 22

independent practice association or independent physician association (follows the HMO philosophy)

Front 23

Lapse

Back 23

termination of coverage for non payment of premiums

Front 24

Medicaid

Back 24

insures persons on public assistance

Front 25

Medicare

Back 25

medical coverage designed for the elderly over 65 years of age

Front 26

PPO

Back 26

preferred provider organization (non HMO plan)

Front 27

Premium

Back 27

periodic payment made by policy holder to insurance company

Front 28

Probationary period

Back 28

the state or a time period of being subject to probation

Front 29

Reciprocity

Back 29

the quality or state of being reciprocal, mutual dependence, action, or influence (2/3=3/2)

Front 30

RVS

Back 30

relative value scale/study or schedule (used to determine how much will be billed to workers' compensation

Front 31

HIC

Back 31

health insurance claim

Front 32

Provider

Back 32

person who provides medical care

Front 33

Subscriber

Back 33

insured or policyholder

Front 34

UCR

Back 34

usual, customary, reasonable

Front 35

Void

Back 35

negate or invalidate

Front 36

Workers' Compensation

Back 36

covers job related illness or injuries