| A | B |
|---|
| benefits | money received for services |
| coinsurance | stated as % |
| copayment | amt $ paid at OV |
| health plan | plan, program or organizaton that provides medical insurance |
| HMO | health maintenance organization |
| MCO | set capitated payments (head count) |
| primary care physician | gatekeeper to coordinate pt care |
| health care provider | individual, group or organization |
| third party payer | govt or private |
| Tricare | military insurance |
| compliance | actions that meet billing regulations |
| diagnosis codes | codes for pt conditions and illness |
| pt pays premium for | companty payments for covered services |
| indemnity | use of any provider |
| 3 parties under insurance contract | pt, provider, insurance company |
| premium,deductible, coinsurance | conditions of indemnity plan |
| medicare,medicaid, workers comp | government insurance |
| patient ledger | pt's financial transactions |
| out of network | not under contract with payer (insurance) |
| annual physical or routine screenings | preventive |
| medical neccesity | coding pts TX correctly |
| HMO with POS | use of any provider |
| HMO | only network providers |
| SOAP | subjective,objective,assessment,plan |
| documentation | systematic,logical and consistant |
| discharge | includes condtion, status and final DX |
| Only the facts | to a specific request are released |
| court orders | info may be released |
| electronic records | more advantages over paper |
| encounter with patient | face to face meeting |
| medical records | legal documents |
| HIPAA | regulates use and disclosure of pts protected health info |
| PHI | protected health information |
| protected health info | name, address, birthday, telephone # |
| notice of privace practices | most be given at first visit |
| authorization of PHI | requires signature and expiration date |
| PHI authorization disclosure | must have group or person receiving |
| NPI | national provider idenitfier |
| HIPAA NPI | will be available for employers, providers health plans and pts |
| abusive actions in legal terms | improper use of some elses resources |
| Health Insurance Portability Accountability Act | HIPAA |
| Pt contacts | document phone calls and emails |
| audit | examination of records |
| Qui tam | whistle blowing of suspected fraud against govt |
| fraud | deception with intent |
| guilty of fraud | may be excluded use of govt programs |
| subpoena duces tecum | appear with paperwork or items |
| subpoena | court order to appear and testify |
| medical standards of care | set standards using expertise reasonably |
| medical records | owned by provider pt owns info |
| HIPAA entities | health plans, clearing houses, providers |
| HIPAA Privacy Rule | protects PHI |
| de-identified | removal of PHI from record |
| compliance plan | continuous traing on coding and billing |
| malpractice | injures pt due to failure to follow medical standard of care |
| encryption | scrambling info so code or key needed |
| business associate | held to task under HIPAA under covered entity |
