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This is a 5-digit code assigned for reporting a procedure performed by the provider.
What is CPT Code?
What is Current Procedural Terminology?
When an insurance plan does not pay for treatment, this is the process of objecting to this decision. The insurer may require documentation and typically has a formal policy or process established for submitting.
What is an Appeal?
10th revision of the International Classification of Diseases. Uses 3 to 7 digits. Includes additional digits to allow more available codes.
What is a ICD 10 Code?
Medical supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.
What is DME?
What is Durable Medical Equipment?
The monthly fee an insurance company charges the subscriber.
What is a premium?
The portion of the charges that are the responsibility of the patient or insured.
What is Financial Responsibility?
International Classification of Diseases classification system used to assign codes to patient diagnosis. This is a 3-to-5-digit number.
What is an ICD 9 Code?
Permission given by a provider for a patient to see a specialist.
What is a Referral?
This is software built on top of basic EHR features that allows providers to prescribe medications, order tests, and give other types of instructions electronically. The goal of is to improve safety and efficiency.
What is CPOE?
What is Computerized Physician Order Entry?
This is a fixed-dollar annual amount of health care costs that the beneficiary must pay entirely out of pocket.
What is a deductible?
Several federal regulations intended to improve the efficiency and effectiveness of health care and establish privacy and security laws for medical records.
What is HIPAA?
What is Health Insurance Portability and Accountability Act?
A unique 10 digit identification number required by HIPAA and assigned through the National Plan and Provider Enumeration System (NPPES).
What is a NPI Number?
What is a National Provider Identifier Number?
When a patient requires permission from the insurance company before receiving certain treatments or services.
What is Authorization?
Focuses on high cost, high touch medication therapy for patients with complex disease states.
What is a Specialty Pharmacy?
Medical treatment that is provided in a medical facility such as a hospital and requires at least one overnight stay
What is inpatient care?
Requirement of insurance plan that provider obtains approval from plan before it will cover the costs of a specific medicine, medical device or procedure.
What is Prior Authorization?
What is a PA?
A request for payment submitted by the provider or hospital to the health insurer.
What is a Claim?
Focuses on a specific area of medicine to diagnose, manage, prevent or treat certain types of symptoms and conditions.
What is specialty care?
Companies such as Life Sciences Companies, Patients and Caregivers, Physicians and Staff and Technology Vendors.
What are Market Stakeholders?
Generally referred to as ambulatory care, medical treatment that does not require an overnight stay
What is outpatient care?
An individual’s identifying information such as name, address, birth date, Social Security Number, telephone numbers, insurance ID numbers, or information pertaining to healthcare diagnosis or treatment.
What is PHI?
What is Protected Health Information?
The amount a patient is responsible for paying that is not covered by the insurance plan.
What is Patient Responsibility?
Involves diagnosing and treating life-threatening illnesses or injuries that need immediate attention.
What is emergency care?
This is a contract that requires a health insurer to pay some or all of an individual or family's health care costs in exchange for a premium.
What is Health insurance?
Focuses on preventing disease through regular physical exams and health screenings in addition to caring for a patient's general health by advising and treating a range of health related issues.
What is primary care?