Med Insurance Ch. 1

Process that results in timely payment for medical services

Services and treatments performed by a practice

Translating a description of a diagnosis or procedure into a standardized code

Physician's opinion of the nature of patient's illness or injury

Health care claim sent electronically

Health document describing a payment resulting from a claim adjudication

Shows services provided to a patient, total payments made, total charges, adjustments and balance due

Combination of the billing cycle and medical documentation cycle of a practice

Electronic transaction or paper document filed to receive benefits

Individual or group plan that provides or pays for medical care

Private or government organization that insures or pays for health care on behalf of beneficiaries

Person who buys an insurance plan

Practice's operating expenses

Computer information that records, stores and manages patient information

Actions that help the provider to receive maximum payment

Business software that organizes and stores a medical practice's financial information

Recording of a pt's health status in a pt's medical record

Computerized lifelong health care record with data from all sources

Financial plan that covers the cost of hospital and medical care

Medical procedures and treatments included as benefits in a health plane

Treatment that is appropriate and rendered in accordance with generally accepted standards of medical practice

Medical procedure's not included in a plan's benefits

Health plan that offers protection from loss

Charging method based on each service performed

Amount the insured must pay for health care services before health plans payment begins

Portion of charges an insured person must pay for health care services after the deductible

Expenses the insured must pay prior to benefits

Organization offering a managed health care plan

System combining the financing and deliver of health care services

Amount a beneficiary must pay at the time of a health care encounter

Prior authorization from a payer for services to be provided

Money the insured pays to a health plan for a policy

Health plan payments for covered services

Person that supplies medical services and bills for or is paid for the services

Monies owed to a medical practice

Administrative medical employee

Movement of monies into or out of a business

Software program that combines both a PMP and a EHR