Chapter 5

Chapter 5 - Term Definition accept assignment participating...

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Term: accept assignment Definition: participating physician's agreement to accept the allowed charge as full payment Term: advance beneficiary notice of noncoverage (ABN) Definition: Medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by Medicare Term: assignment of benefits Definition: authorization by a policyholder that allows a health plan to pay benefits directly to a provider Term: birthday rule Definition: guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary
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Term: capitated plan Definition: insurance plan in which prepayments made to a physician cover the physician's services to a plan member for a specified period of time Term: case Definition: grouping of transactions for visits to a physician office organized around a specific medical condition Term: chart Definition: folder that contains all records
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