Unit 2 Medical Terms

Question 1

An unexpected happening, causing injury traceable to a definite time and place.

Answer 1

Accident

Question 2

The process of paying claims submitted or denying them them after comparing the claim to benefit and coverage requirements;

(also known as a claims settlement)

Answer 2

Adjudication

Question 3

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

Answer 3

Claims Examiner

Question 4

The dollar and cents amount that is established for one unit as applied to a procedure or service rendered. This unit is then used to CONVERT various procedures into fee schedule payment amounts by multiplying the relative value unit by the conversion factor.

Answer 4

Conversion factor

Question 5

An agreement arrived at, whether in or out of court, for settling a workers compensation case after the patient has been declared permanent and stationary.

Answer 5

Compromise and release

Question 6

The science and technology that seek to fit the anatomic and physical needs of the worker to the workplace.

Answer 6

Ergonomic