exam 1 Flashcards
definition of premium
buying the insurance
definition of co-pay
portion of what the patient has to pay
definition of co-insurance
secondary insurance
definition of deductible
money that must be paid before an insurance company will pay a claim
GX
other service
collect from pt
definition of explanation of benefits (EOB)
statement of what services will be covered by the insurance
definition of verification
what shows your identity
definition of PAR
agree to accept assignment for all covered services that you provide to Medicare patients
definition of non-PAR
no agreement to all services, but you still bill Medicare part B
definition of CMS
“Center for medicare services”
makes decisions in the healthcare industry
definition of OIG
“office of inspector general”
prevents inefficient or unlawful operations
definition of NPI
“national provider identifier”
identifies a business
definition of medical necessity
services or items reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member
definition of enrollment in medicare
online tutorials with an NPI
definition of initial visit
CC, HPI, family hx, past health hx, tx, dx, tx plan
definition of treatment plan
length, frequency, what will be done, how to measure it, goals
definition of quality assurance
the maintenance of a desired level of quality in a service or product, especially by means of attention to every stage of the process of delivery or production
definition of utilization review
health insurance company’s opportunity to review a request for medical treatment
definition of HCPCS
“Healthcare Common Procedure Coding System”
standardized code sets
definition of ICD-10-CM
“clinical modification”
Captures morbidity and mortality statistics
definition of CPT-4
medical billing and coding
who can see a medicare patient
PAR and non-PAR
what plans might pay for chiropractic care
parts B and C
what are the first visit requirements
subluxation, CC
ABN
