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MBIC- module 1 > Unit 1 Medical Terms > Flashcards

Unit 1 Medical Terms Flashcards

1
Q

The process of ensuring that customers PAY their dues on time.

A

Accounts Receivable Management

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2
Q

The comprehensive health care reform law enacted in march 2010

(also known as Obamacare)

A

Affordable Care Act (ACA)

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3
Q

A TASK or piece of work assigned to someone as part of a job or course of study

A

Assignment

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4
Q

This is a method used to determine when a plan is primary or secondary for a dependent child when covered by both parents’ benefit plan. The parent whose birthday falls first in a calendar year is the parent with the primary coverage for the dependent

A

Birthday Rule

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5
Q

An agreement to spend a predetermined amount with a specified vendor over a period of time.

(A type of contract that COVERS a wide range of products and services.)

A

Blanket contract

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6
Q

Something that can be rescinded or UNDONE. When you can get out of a contract without paying a penalty

A

Cancelable

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7
Q

A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of healthcare services that must be provided to patients is included in the contract

(FIXED -amount type health care payment system)

A

Capitation

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8
Q

A STATEMENT from a patient or health care provider presented to an insurance company or HMO for payments for services performed

A

Claim

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9
Q

The amount, generally expressed as a fixed percentage, an INSURED must pay against a claim after the deductible is satisfied.

A

Coinsurance

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10
Q

A type of MCO created by the 1982 Tax equity and fiscal responsibility act to facilitate the enrollment of Medicare beneficiaries into managed care plans.

(ALTERNATIVE health care delivery mechanisms)

A

Competitive Medical Plan

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11
Q

Allows plans that provide health and/or prescription coverage for a person with medicare to determine their respective payment responsibilities

(PROCESS of determining which two or more insurance policies will have the primary responsibility of processing/paying a claim)

A

Coordination of benefits (COB)

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12
Q

A PAYMENT made by a beneficiary in addition to that made by an insurer

A

Copayment

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13
Q

The SHARE of costs covered by your insurance that you pay our of your own pocket

A

Cost sharing

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14
Q

A PAGE that lists all health care procedures, payments, and adjustments for a single day, used in some accounting systems

A

Daysheet

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15
Q

The amount YOU PAY for covered health care services before your insurance plan starts to pay.

A

Deductible

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16
Q

A form of health insurance that provides periodic payments to replace income when the insured is UNABLE to work as a result of illness, injury, or disease and not as result of work related accident or condition

A

Disability income insurance

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17
Q

A legal way to get CONSENT or approval on electronic documents or forms.

A

Electronic signature

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18
Q

A person younger than 18 years of age who lives independently, is totally self supporting , and possesses decision-making rights.

A

Emancipated minor

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19
Q

A key component in accurate billing and collections. The document services rendered by capturing the diagnosis and procedure codes.

(A service FORM that lists health care procedure codes completed during a patients office visit)

A

Encounter form

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20
Q

Organized Marketplace where uninsured individuals and small-business owners can find health insurance coverage and select from all of the Qualified health plans available in their area.
(AKA Health Benefit Exchanges)

A

exchanges

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21
Q

Provisions written into the insurance contract DENYING coverage or limiting the scope of coverage.

A

exclusions

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22
Q

A verbal or written AGREEMENT

A

Expressed contract

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23
Q

A method of payment in which the patient PAYS the health care organization or provider for SERVICES performed from an established schedule of fees

A

Fee of service

24
Q

A CLAUSE in an insurance policy that means the insurance company MUST renew the policy as long as premiums payments are made.

(A policy feature that endures that an insurer is obligated to continue coverage as long as premiums are paid on the policy)

A

Guaranteed renewable

25
Q

A contract between the policyholder or member and INSURANCE carrier or government programs to reimburse the policyholder or member for all or a portion of the cost of medical care rendered by health care professionals; generic term applying to lost income arising from illness or injury, also known as accident and health insurance or disability income insurance.

(A type of Insurance coverage that typically pays for medical, surgical, prescription drug and sometimes dental expenses incurred by the insured.)

A

Health insurance

26
Q

A Contract between physicians and patient not manifested by direct words but IMPLIED or deduced from the circumstance, general language, or conduct of the patient.

A

Implied contract

27
Q

A health insurance policy designed to offset HEAVY medical expenses resulting from CATASTROPHIC or prolonged illness or injury

A

Major Medical

28
Q

Health service REQUIRED by state and/or federal law that may be given to a patient for a specific health condition. This health service may be delivered by certain types of health care providers for some categories of dependents, such as children placed for adoption.

(Also referred to as mandated services)

A

Mandated benefits

29
Q

A FEDERALLY AIDED, state-operated, and state-administered program that providers medical benefits for certain low-income persons in need of health and medical care.

A

Medicaid

30
Q

A NATIONWIDE health insurance program for people age 65 years of age and older and certain disabled or blind persons regardless of income, administered by Centers for Medicare and Medicaid Services (CMS)

A

Medicare

31
Q

A health care organization, physician, or provider who has NOT entered into a contractual agreement with a specific insurance plan.

(Has not entered into an agreement to accept assignment on all medicare claims)

A

Non participation physician or provider

32
Q

An insurance policy RENEWAL provision in which the insurer has THE RIGHT TO REFUSE to renew the policy on a date and may add coverage limitations or increase premium rates

A

Optionally renewable

33
Q

A managed care plan in which members are given a choice as to how to receive services, whether through a health maintenance organization, preferred provider organization, or fee-for service plan.

(A managed-care health insurance plan that provides different benefits for using in-network or out-of-network providers)

A

Point of service plan (POS plan)

34
Q

A requirement of some health insurance plans to obtain PERMISSION for a service or procedure before it is done and to see whether the insurance program agrees that it is medically necessary.

A

Preauthorization

35
Q

A procedure done to determine whether treatment is covered under a patients health insurance policy

A

Precertification

36
Q

A financial inquiry done BEFORE TREATMENT TO DETERMINE the maximum dollar amount the insurance company will pay for surgery, consultations, postoperative care, and so forth

A

Predetermination

37
Q

An individual who PROMISES to pay the medical bill by signing a form agreeing to pay or who accepts treatments, which constitutes an expressed promise

A

Guarantor.

38
Q

Illness or injuries acquired by the patient BEFORE enrollment in an insurance plan

A

Pre existing conditions

39
Q

A type of health benefit program in which enrollees receive the HIGHEST LEVEL of benefits when they obtain services from a physician, hospital, or other health care provider designated by their program as a “preferred provider”

A

Preferred provider organization

40
Q

The cost of insurance coverage paid annually, semiannually, or monthly to keep the policy in force.

A

Premium

41
Q

A government-sponsored program that provides military and nonmilitary hospital and medical services. It covers spouses and dependents of active service personnel and their dependents, and dependents of member who have died in active duty.

A

TRICARE

42
Q

A program for VETERANS with total, permanent, service-connected disabilities or surviving spouses and dependents of veterans who died of service-connected disabilities.

Formerly known as Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

A

Veterans health administration (CHAMPVA)

43
Q

The amount of ACTUAL CASH generated and available for use within a given period of time.

A

Cash flow

44
Q

A practitioner who WORKS for the consumer and helps patients to organize, complete, file, and negotiate health insurance claims of all types to obtain maximum benefits as well as tells patients what checks to write to providers to eliminate over payment

A

Claims assistance professional

45
Q

A representative of the insurer who authorizes treatment and INVESTIGATES, evaluates, and negotiates the patient;s insurance claim and acts for the company in the settlement of claims; also known as claims adjuster, claims representative, and claims administrator.

A

claims examiner

46
Q

A complete set of events that are REPEATED on a regular basis.

A

Cycle

47
Q

Electronic MESSAGE that is transmitted, received, stored, or forwarded text, voice messages, attachments, or images by computer from one person to another or from one person to a defined group or all users on a system.

A

Electronic Mail

48
Q

Standards of CONDUCT generally accepted as a moral guide for a behavior by which an insurance billing or coding specialist may determine the appropriateness of his or her conduct in a relationship with patients, the physician, co-workers, the government, and insurance companies

A

Ethics

49
Q

Customs, rules of conduct, COURTESY, AND MANNERS of the medical profession

A

etiquette

50
Q

CHARGING for services done in hospitals, acute care hospitals, skilled nursing or long-term care facilities, rehabilitation centers, or ambulatory surgical centers

A

Facility billing

51
Q

A practitioner who carries out claims competition, coding, and billing responsibilities and may or may not perform managerial and supervisory functions.

(also known as an insurance claims processor, reimbursement specialist, medical billing representative, or senior billing representative.)

A

Insurance billing specialist

52
Q

An online computer SERVICE run from a website where questions may be posted by subscribers

A

List service

53
Q

(Insurance billing specialist)

A

Medical Billing Representative

54
Q

“Let the master answer”.

Refers to a physicians liability in certain cases for the wrongful acts of his or her assistants or employee

A

Respondeat superior

55
Q

Traditional or fee-for service health insurance plan that allows patients maximum flexibility and choice of provider for a fixed monthly premium. Medical services are paid at a percentage of covered benefits after an annual deductible is paid.

(Allows you to direct your own health care and visit almost any doctor or hospital you like. )

A

Indemnity Health insurance

MBIC- module 1 (12 decks)

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