Who are you? Who? Who? Who? Who?
A health insurance plan or another entity that processes and pays healthcare bills.
Who is the Third Party Payer- Payer- Carrier- Insurer?
PCP
Who is the Primary Care Provider?
Part A
Part B
Part C or Medicare Advantage
Part D
What are Medicare Terms?
The person who is responsible for payment of the bill.
Who is the Guarantor?
An electronic record of a patient health information generated by one or more encounters for a single healthcare organization
What is an EMR?
- Electronic Medical Record
The insurer or entity with first priority for payment of a bill.
Who is the Primary Payer?
DOL
What is Date of Loss?
We submit a bill to get payment for the healthcare services provided to the Patient.
What are Bill Terms?
- The terms bill and claim are often used inter-changeably in healthcare.
A person who depends on someone else for support, such as a child or elderly parent.
Who is a Dependent?
- A minor who is a dependent cannot be the Guarantor. The Guarantor for a dependent minor must be an adult.
PPO - Providers can join healthcare plan network by agreeing to provide services to the healthcare plan's Beneficiaries for a negotiated rate.
What is a Provider Preferred Provider Organization?
- The providers are members of a preferred provider organization or PPO.
These terms are interchangeable and represent any person covered by the healthcare insurance plan. An insured may elect to have other family members covered under the healthcare plan's family option. The family members are also considered beneficiaries, enrollees, or members
Who is the Beneficiary - Enrollee - Member?
TPL
What is Third Party Liability?
- ex: Auto Insurance
A form signed by the Patient giving the healthcare provider authority to bill his/her insurance plan and receive payment is called the assignment of benefits.
What are Benefit Terms?
A person who is responsible for the care and/or property of another.
Who is a Guardian?
A master file in the computer system listing the services provided at the provider that have an assigned charge.
What is the Charge Description Master?
The individual who initiates healthcare coverage through an employer, private health plan, or other payer.
Who is the Insured - Subscriber - Policyholder - Sponsor?
DOD
What is Date of Death?
Monument Health's electronic health record.
What is EPIC?
A person, official, or institution designed to take over and protect the interests of an incompetent person. This includes being responsible for paying the individual's healthcare bills.
Who is a Conservator?
A master file in the computer system listing the payers, such as Medicare, Medicaid, and other health insurance plans.
What is the Payer Master List?
The insurer or entity with the second priority for payment of the bill, after the primary payer.
Who is the Secondary Payer?
LOA
What is Leave of Absence?
ICD-10-CM represents International Classification of Diseases, 10th revision, Clinical Modification.
HCPCS represents Healthcare Common Procedure Coding System.
CPT represents Level I HCPCS, or the Physicians Current Procedure Terminology, which is authored by the American Medical Association, or AMA.
What are Coding Terms?
Minors that have been released from their parents control and supervision and are responsible for themselves
What is Emancipated?
Allows direct entry of medical orders by a licensed healthcare provider. This method of order entry is being increasingly encouraged as an important solution to the challenge of reducing medical errors, and improving health care quality and efficiency.
What is a Computerized Provider Order Entry?