Chapter 5 Flashcards

insurance plan
Terms Definitions
accept assignment
participating physician's agreement to accept the allowed charge as full payment
advance beneficiary notice of noncoverage (ABN)
Medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by Medicare
assignment of benefits
authorization by a policyholder that allows a health plan to pay benefits directly to a provider
birthday rule
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
capitated plan
insurance plan in which prepayments made to a physician cover the physician's services to a plan member for a specified period of time
grouping of transactions for visits to a physician office organized around a specific medical condition
folder that contains all records pertaining to a patient
coordination of benefits (COB)
clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim
financial policy
practice's rules governing payment for medical services from patients
person who is the insurance policyholder for a patient of the practice
patient information form
form that includes a patient's personal, employment, and insurance data needed to complete a health care claim; also known as a registration form
patient tracking features
function attached to the electronic scheduler that is used during a patient encounter to track where the patient is during the different steps of the encounter
primary insurance plan
health plan that pays benefits first when a patient is covered by more than one plan
record of treatment and progress
physician's notes about a patient's condition and diagnosis
referring provider
physician who refers the patient to another physician for treatment
process of gathering personal and insurance information about a patient before an encounter with a provider
secondary insurance plan
health plan that pays benefits after the primary plan pays when a patient is covered by more than one plan
in TRICARE, the active-duty service member
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