Billing Week 1 Flashcards
(20 cards)
Subscriber
The insured
Coinsurance
The insured is required to pay a percentage of the covered service costs
Deductible
A specific amount of money that must be paid each year before the policy benefits begin
Contract
A legal and binding written document that exists between two or more parties
Fraud
An intentional misrepresentation of the facts to deceive or mislead another
Covered entity
An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA
Birthday Rule
An informal rule that the health insurance industry has adopted for the coordination of benefits when children are listed as dependents on two parents health plan. The health plan of the parent whose birthday comes first in the calendar year is designed as the primary
Primary Care Physician
Oversees the care of patients in a managed health care plan and refers patients to specialists
Chief complaint CC
A patients statement describing symptoms, problems, or conditions as the reason for seeking health care services from a physician
Emergency
A sudden and unexpected medical condition or the worsening of a condition that poses a threat to life, limb, or sight and requires immediate treatment to alleviate suffering
Patient registration form
Comprehensive listing of personal and financial information requested from the patient.. first visit to the office
Eligibility
Verification to see if the patient is a member of the insurance plan and that the member identification number is correct
Computer billing
Computer generated billing statements
Uncovered procedure
also known as a non-covered service, is a healthcare service or procedure for which an insurance company or government payer will not provide reimbursement
Third Party
an entity other than the buyer and seller who is involved in the financial transaction. This can be a payment processor, an insurance company, a government agency, or any other organization that handles payments or invoices on behalf of the primary parties.
Group practice
collective of two or more healthcare providers, typically physicians, who operate under a single legal entity, such as a partnership or corporation.
Patient Ledger
a detailed record of all financial transactions related to a specific patient’s healthcare services
First Party
The patient or the person financially responsible for the health bill
Superbill
provides detailed information about a patient’s healthcare services. It serves as a summary of the encounter between the patient and the healthcare provider
Second Party
The healthcare provider (physician, hospital, clinic, etc.) delivering the care
