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32 Cards in this Set

  • Front
  • Back
accounting cycle
the flow of financial transactions in a business
accounts receivable
term used to describe money coming into a business
capitatioin
a fixed amount that is paid to a provider in advance
coinsurance
part of charges that an insured person must pay for health car services after payment of the deductible amount.
copayment
a small fixed fee payed by the patient at the time of the office visit.
diagnosis code
a value that stands for a patients illness signs or symptoms
encounter form
a form listing procedures relevant to the specialty of a medical office, used to record the procedures
explanation of benefits
a paper document from a health plan that lists the amount of a benefit and explains how it was determined
fee-for-service
an insurance plan inwhich plicy holders are reimburesed for health care costs.
procedure code
a number that represents medical procedures performed by a provider
remittance advice
an electronic document from a health plan tha tlists the amount of a benefit and explains how it was determined
health maintenance organization
a type of managed care system in which providers are paid fixed rates at regular intervals
health plan
a plan, program, or organization that provides health benefits
managed care
a type of insurance in which the carrier is responsible for the financing and delivery of health care
patient information form
a document that contains personal employment, and medical insurance information about a patient
payer
private or government organization that insures or pays ofr health care
policy holder
an individual who has contracted with a health plan for coverage
ppo preferred provider organization
a network of health care providers who agree to provide services to plan memebers at a discounted fee
premium
a payment made to a health plan by a policy holder for coverage
audit/edit report
a report that lists errors in a claim
protected health information
information about a patients past, present or future physical or mental health or payment for health care that can be used to identify the person
clearinghouse
an organization that receives claims from a provider, checks and prepares them for processing, and trasmits them to insurance carriers in a standardized format.
electronic prescribing
the use of computers and handheld devices to write and transmit prescriptions to a pharmacy in a secure digital format
national provider number
a national standard identifier for all health care providers consisting of ten numbers
electronic data interchange (edi)
the transfer of business transactions from one computer to another using communications protocols
practice management program (pmp)
a software program that automates many of the administrative and financial tasks required to run a medical practice
electronic medical records (emr)
the electronic collections and mangement of health information
hipaa security rule
regulations outlining the minmum safeguards required to prevent unauthorized access to electronic health care information
information technology
computer hardware and software systems
walkoiut statement
a document listing charges and payments that is given to a patient after an office visit
x12-837 health care claim
hipaa standard format for electronic transmission of a professional claim from a procider to a health plan.
hipaa electronic transaction and code sets standards
regulations that require lectronic transactions to use standardized formats