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Insurance terms.1
insurance terms
Term | Definition |
---|---|
Abuse | actions inconsistent with accepted, sound, medical, business, or fiscal practices |
Fraud | Intentional deception or misrepresentation that could result in an unauthorized payment |
Medical Malpractice Insurance | A type of liability insurance that covers physicians and other healthcare professionals for liability claims arising from patient treatment |
Medical Necessity | Involves linking every procedure or service code reported on an insurance claim to a condition code that justifies the need to perform that procedure or service |
Preauthorization | Prior approval |
Remittance Advice (remit) | Electronic or paper-based report of payment sent by the payer to provider; includes patient name, patient health insurance number, facility provider number/name, dates of service, type of bill (TOB), charges, payment information, and reason/remark codes |
Respondent Superior | Latin for "let the master answer"; legal doctrine holding that the employer is liable fro the actions and omissions of employees performed and committed within the scope of their employment |
Scope of Practice | Health care services, determined by the state, that an NP and PA can perform |
Stand-alone Code | CPT code that includes a complete description of the procedure or service |
Statute of Limitations | A statute prescribing a period of limitation for the bringing of certain kinds of legal action |
Subpoena | An order of the court that requires a witness to appear at a particular time and place to testify |
Coinsurance | Also called coinsurance payment; the percentage the patient pays for covered services after the deductible has been met and the copayment has been met |