Medical Vocabulary
A consent document that informs the patient they may be financially liable for the costs should their insurance carrier deny the claim. The ABN must be completed and signed by the patient before providing services or items not covered by insurance.
What is ABN
The ICD-10-CM Index utilizes three levels of indentation in the Alphabetic Index.
What is
Main terms
■ Subterms
■ Carryover line
What are the 2 Medicare program established in 1965
what is Part A and Part B
Explanation of benefits
What is EOB
an informal rule that the health insurance industry has widely adopted for the COBs when children are listed as dependents on two parents’ health plans
What is the birthday rule
health care services or supplies that are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
What is Medical Necessity
a privileged communication that may be disclosed only with the patient’s permission.
What is Confidential communication
Medicaid is administered by states with partial federal funding.
What is Medicaid
Medicare Secondary Payer
What is MSP
What the 4 parts of Medicare
What is Part A,B,C,D
Describes the category of service performed
What of Type of Service
an entity, such as an insurance company, governmental agency, or employer, that reimburses health care expenses.
What is third party payer
What acronym is a service benefit program for permanently and totally disabled veterans with dependents and survivors of veterans who have died
What is CHAMPVA
International Classification of Diseases Tenth Revision. ICD-10-CM (clinical modification
relates not only to whether a service or procedure is covered but also to finding out whether it is medically necessary.
What is Preauthorization
Amount (typically a percentage) a patient pays the healthcare provider once the patient’s insurance has paid its portion (based on their benefit contract). Oftentimes, the patient must meet their deductible before co-insurance kicks in
Co-Insurance
a legal and binding written document that exists between two or more parties
What is a contract
What is the civilian health care program of the US Department of Defense (DOD) Military Health System
What is TRICARE
Date of service
What is Date of Service
refers to discovering whether treatments such as surgeries, hospitalizations, or tests are covered under a patient’s contract.
What is pre- certification
A fixed fee that the patient pays the healthcare provider for the services or treatment received
What is Co-pay
is a person who accepts treatment or signs a form agreeing to pay
What is a guarantor
Who runs Medicare and Medicaid
What is CMS
Cordination of benefits
What is COB
discovering the maximum dollar amount that the carrier will pay for surgery, consulting services, radiology procedures, and so on
What is Predetermination