ASSIGNMENT OF BENEFITS / A THIRD-PARTY PAYER PAYS BENEFITS DIRECTLY TO PROVIDER
BALANCE BILLING / COLLECTING FROM THE PATIENT THE DIFFERENCE BETWEEN PROVIDER’S USUAL FEE AND INSURER’S LOWER ALLOWED CHARGE, OR ANY BALANCE LEFT ON ACCOUNT AFTER INSURANCE HAS PAID THEIR PORTION
BIRTHDAY RULE / GUIDELINE TO DETERMINE WHICH PARENT WITH MEDICAL COVERAGE HAS THE PRIMARY INSURANCE FOR A DEPENDENT
CAPITATION PLAN / INSURANCE CARRIER’S PREPAYMENT OF A FIXED AMOUNT TO A PHYSICIAN TO COVER INSURED SERVICES
CARRIER/INSURER / INSURANCE COMPANY
COINSURANCE / PERCENTAGE OF EACH CLAIM THAT THE INSURED MUST PAY
COORDINATION OF BENEFITS / CLAUSE THAT A PATIENT WITH TWO INSURANCE POLICIES CAN HAVE ONLY 100% CARE COVERED
COPAYMENT / AMOUNT PAID BY PATIENT FOR EACH VISIT
CUSTOMARY FEE / A PHYSICIAN’S CHARGE FOR A SERVICE OR PROCEDURE DETERMINED BY WHAT PHYSICIAN’S WITH SIMILAR TRAINING AND EXPERIENCE IN A CERTAIN GEOGRAPHICAL AREA TYPICALLY CHARGE.
DEDUCTIBLE / THE AMOUNT THAT THE INSURED MUST INCUR BEFORE INSURANCE BEGINS PAYING BENEFITS
HCPCS / HEALTH CARE FINANCING ADMINISTRATION’S COMMON PROCEDURE CODING SYSTEM USED IN CODING SERVICES FOR MEDCARE PATIENTS
HMO / HEALTH CARE MAINTAINENCE ORGANIZATION (MANAGED CARE FACILITY)
INDEMNITY PLAN / INSURANCE THAT PROVIDES A PERCENTAGE OF PAYMENT TO THE PHYSICIAN ON A FEE-FOR-SERVICE BASIS WITH THE PATIENT ASSUMING RESPONIBILITY FOR THE REMAINING PORTION OF THE COST
INSURED/SUBSCRIBER/ENROLLE/
POLICY HOLDER / PERSON WHO TAKES OUT INSURANCE
ICD-9 / INTERNATIONAL CLASSIFICATION OF DISEASES, 9TH REVISION, CLINICAL MODIFICATION, LIST OF CODES FOR DISEASES AND CONDITIONS
CPT / CURRENT PROCEDURAL TERMINOLOGY, CONTAINS MOST COMMONLY USED SYSTEM OF PROCEDURE CODES
PPO / MANAGED PLAN THAT CONTRACTS WITH PHYSICIANS TO PERFORM SERVICES AT SPECIFIED RATES
PREAUTHORIZATION / PHYSICIAN OBTAINS PERMISSION FROM THE INSURANCE PLAN BEFORE DELIVERING SERVICES
PREMIUM / RATE CHARGED TO POLICYHOLDER FOR INSURANCE PLAN
PRIMARY CARE PROVIDER / PHYSICIAN WHO COORDINATES PATIENT’S OVERALL CARE AND ENSURES THAT VARIOUS MEDICAL SERVICES ARE NECESSARY
PROVIDER / PHYSCIAN OR OTHER HEALTH CARE PROFESSIONAL WHO PROVIDES TREATMENT
REFERRAL / PRIMARY CARE PROVIDER RECOMMENDS THAT THE PATIENT USE A SPECIALIST FOR A SPECIFIC SERVICE
THIRD-PARTY PAYER / INSURANCE COMPANY THAT AGREES TO PAY FOR INSURED’S MEDICAL SERVICES OR A PORTION OF IT
WORKER’S COMPENSATION / STATE LAW AND INSURANCE PLAN REQUIRING EMPLOYERS TO OBTAIN INSURANE IN CASE OF EMPLOYEE ACCIDENT OR INJURY
EMPATHY / PUTTING YOURSELF IN ANOTHERS PLACE
INITIATIVE / TO TAKE ACTION INDEPENDENTLY
TACT / ABILITY TO SPEAK AND ACT CONSIDERATELY
EFFICIENCY / USE TIME AND OTHER RESOURCES TO AVIOD WASTE AND UNNECESSARY EFFORT
ABANDONMENT / PHYSICIAN’S LEAVING A CASE BEFORE PATIENT IS RECOVERED
BIOETHICS / ISSUES ABOUT CURRENT MEDICAL TREATMENT, TECHNOLOGY, AND PROCEDURES.
FRAUD / DEPRIVING OTHERS OF THEIR RIGHTS BY DISHONEST MEANS
INFORMED CONSENT / PATIENT’S PROBLEM OR PROCEDURE, TREATMENT OPTIONS, AND PROGNOSIS HAVE BEEN EXPLAINED IN SIMPLE, UNDERSTANDABLE LANGUAGE
RELEASE OF INFORMATION / AUTHORIZATION TO SEND PATIENT’S INFORMATION TO ANOTHER FACILITY
NO SHOW / PATIENT WHO FAILS TO SHOW UP FOR SCHEDULED APPOINTMENT
TRIAGE / DETERMINING HOW SOON A PATIENT NEEDS TO BE SEEN BY PROVIDER
(SCREENING)
NP / NEW PATIENT
EP / ESTABLISHED PATIENT
CORRECT MESSAGE
TAKING / GET PATIENT’S
NAME
PHONE #
REASON FOR CALL
APPOINTMENT SCHEDULING / PATIENT NAME
REASON FOR APPOINTMENT
PHONE #
(CC)
CHIEF COMPLAINT / REASON FOR VISIT
DIAGNOSIS
(DX) / ASSESSMENT OR IMPRESSION OF PATIENT’S CONDITION
(FH)
FAMILY HISTORY / HEALTH FACTS OF PATIENTS FAMILY AND BLOOD RELATIVES
(PE)
PHYSICAL EXAM / ANNUAL VISIT OF PATIENT BY PHYSICIAN
SUBJECTIVE / PATIENT’S DESCRIPTION OF PROBLEM OR COMPLAINT, ANY OUTSIDE SYMPTOMS WHEN THEY BEGAN AND PAST TREATMENT
HIPAA / HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
OSHA / LAWS AND REGULATIONS PERTAINING TO THE WORKPLACE
CARRIER/THIRD PARTY / INSURANCE COMPANY OR ANY PLAN THAT IS RESPONSIBLE FOR A PORTION OF PATIENTS CHARGES AND ADMINISTERS THE PLAN
CLAIM FORM / FORM USED TO PRESENT CLAIM INFORMATION TO THE CARRIER IN AN ORGANIZED MANNER
ELECTRONIC CLAIM FILING / SEND CLAIM FORMS OVER THE INTERNET TO A CLEARING HOUSE
EXCLUSIONS / SPECIFIC SERVICES OR CONDITIONS WHICH THE POLICY WILL NOT COVER
MAXIMUMS / THE TOP LIMIT OF THE AMOUNT A CARRIER WILL PAY FOR A SPECIFIC CALANDER YEAR OR POLICY
PROOF OF ELEGIBILITY/VERIFY ELEGIBILIY / EVIDENCE IN WRITING OR OVER THE PHONE THAT THE PATIENT HAS A POLICY IN EFFECT AT TIME OF TREATMENT
PRIMARY CARRIER / THE INSURANCE CARRIER THAT HAS FIRST RESPONSIBILTY UNDER COORDINATION OF BENEFITS
SECONDARY CARRIER / INSURANCE CARRIER WHICH IS SECOND IN RESPONSIBILITY UNDER COORDINATION OF BENEFITS
GUARANTOR / PERSON RESPONSIBLE FOR PAYING ON ACCOUNT
DAY SHEET OR JOURNAL / ACCOUNT OF ALL CHARGES, PAYMENTS AND AJUSTMENTS THE PROVIDER DOES IN A DAY
EOB / EXPLANATION OF BENEFITS
POSTING / ENTERING IN ON A COMPUTER OR SPREADSHEET THE CHARGES, PAYMENTS AND ADJUSTMENTS FOR THE OFFICE
RTC / RETURN TO CLINIC
FU
/ FOLLOW UP APPOINTMENTCLEARING HOUSE
/ CARRIER SERVICE BUREAU THAT REVIEWS ELECTRONIC CLAIMS THEN FORWARDS THEM TO APPROPRIATE INSURANCEENCOUNTER FORM, SUPER BILL, ROUTING SLIP / PROVIDER FILLS OUT AFTER SERVICES HAVE BEEN PERFORMED, AND GIVES TO BILLER
PATIENT LEDGER / LIST OF SERVICES AND PAYMENTS OR ADJUSTMENTS ON PATIENT’S ACCOUNT
PRIMARY CARRIER
/ THE INSURANCE CARRIER THAT HAS FIRST RESPONSIBILITY UNDER COORDINATION OF BENEFITSCARRIER/THIRD PARTY
/ INSURANCE COMPANY OR ANY PLAN THAT IS RESPONSIBLE FOR A PORTION OF PATIENTS CHARGES AND ADMMINISTERS THE PLANDEPENDENT
/ USUALLY CHILDREN UNDER A SPECIFIED AGE SUCH AS AGE 21 OR 25 IF FULL TIME STUDENTCLAIM FORM / FORM USED TO PRESENT CLAIM INFORMATION TO THE CARRIER IN AN ORGANIZED MANNER
MAXIMUMS / THE TOP LIMIT OF THE AMOUNT A CARRIER WILL PAY FOR A SPECIFIC CALANDER YEAR OR POLICY
ERA / ELECTRONIC REMITTANCE ADVICE
FEE ADJUSTMENT / REDUCING THE COST OF A PROCEDURE OR SERVICE
FEE SCHEDULE / THE PROVIDERS LIST OF USUAL COSTS FOR SERVICES
DIFFERENT TYPES OF INSURANCE COVERAGE /
BLUE CROSS
MEDICARE
MEDICAID
TRICARE/CHAMPUSINDEMNITY PLANS
PPO/HMO/CAPITATION PLANS
ELECTRONIC CLAIM FILING / SEND CLAIM FORMS OVER THE INTERNET TO A CLEARING HOUSE
FU /