he World Health Organization (WHO) developed the International Classification of Disease (ICD)
What is 1948
100
language that is used to accurately describe the human body and associated components, and conditions.
What is medical terminology
100
a fixed fee paid at each visit for each service rendered
What is a copay
100
capitation, fee-for-service, managed fee-for-service, and episode of care.
What is methods of third party reimbursement
200
Health Maintenance Organizations
What is HMO
200
AMA (American Medical Association) developed a procedural coding system to standardize procedural terminology used on insurance claims.
What is 1966
200
have a basic understanding of how the body functions in order to recognize abnormal body conditions
What is anatomy and physiology
200
Payment is made for only medically necessary treatment,
What is a fee for service plan
200
payment method in which the health care provider receives one lump sum for all services rendered to the patient for a specific illness.
What is episode of care
300
American Medical Association
What is AMA
300
Congress enacted the HMO Act of 1973, which allowed the government to assist HMOs
What is 1973
300
must be able to discriminate between technical descriptions of two different, but similar, procedures or diagnoses.
What is critical reading
300
a specified amount of annual out-of-pocket expenses for covered health care services the insured must pay for health care before the insurer pays benefits.
What is a deductible
300
the traditional form of payment to providers for services performed. Payment may be made by either the patient or a third-party payer.
What is fee for service
400
Primary Care Provider
What is PCP
400
Carter Administration combined the Medicare and Medicaid programs under a single administrative agency, the Health Care Financing Administration (HCFA).
What is 1977
400
In order to submit claims electronically, the insurance specialist must be comfortable with the use of computerized equipment and data entry.
What is data entry ability
400
Medicare nonparticipating providers (those who don’t accept assignment) cannot charge more than 15% of the nonparticipating provider’s Medicare reimbursement.
What is a nonparticipating limited fee
400
the method used by HMOs and other managed care plans to pay the health care providers a fixed amount on a per capita (per person) basis.
What is capitation
500
Civilian Health and Medical Program of the Uniformed Service
What is CHAMPUS
500
Medicare began requiring physicians’ offices to submit the ICD-9-CM codes on HCFA-1500 claims.
What is 1984
500
the principle of right or good conduct, and rules that govern the conduct of members of a profession.
What is code of ethics
500
the process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on an insurance claim form.
What is coding
500
fee paid to the surgeon that covers a preoperative visit, the surgery, and normal postoperative care.