chapter 5 Flashcards
accept assignment
a participating physicians agreement to accept the allowed charge as payment in full
advance beneficiary of noncoverage (ABN)
medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by medicare
assignment of benefits
authorization by a policyholder that allows a health plan to pay benefits directly to a provider
birthday rule
guidelines that determines which of the two patients with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary
capitate plan
insurance plan in which prepayment made to a physicians cover the physicians services to a plan member for a specified period of time
case
grouping of transaction for visits to a physician office organized around a specific medical condition
chart
folder that contains all records pertaining to a patient
chart number
unique alphanumeric codes that identifies a patient
coordination of benefits (COB)
clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim
financial policy
practice rules governing payment for medical services from patients
guarantor
person who is the insurance policyholder for a patient of the practice
patient information form
form that includes a patients personal, employment and insurance data needed to complete a health care claim: also known as a registration form
patient tracking features
function attached to the electronic schedule that is used during a patients encounter to track where the patient is during the different steps of the encounter
primary insurance plan
health plan that pays benefits first when a patient is covered by more than one plan
record of treatment and progress
physicians notes about a patients condition and diagnosis
