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billing and coding 2

medical billing and coding chapter 2

TermDefinition
coinsurance predetermined percentage the patient is responsible to pay for covered services.
copayment fixed amount that a patient pays for specific services.
covered benefits services outlined in the policy that re payable by the health plan.
deductible amount patient must pay before the insurance will begin to pay for covered benefits.
HMO health maintenance organization. contracted providers that agree to the payment contract for its members.
noncovered services services that are not payable by the health plan.
out-of-network a provider who does not have signed agreement with an insurance plan.
policyholder the individual who signs a contract with a health insurance company
PPO preferred provider organization. providers join networks and are consider preferred when a patient seeks treatment.
ICD-10-CM international classification of disease, 10th revision, clinical modification.
Medical record contains facts, findings, and observations about a patient’s health.
Malpractice a failure to use professional skill when giving medical services that results in injury or harm.
EHR electronic health record are computerized, lifelong healthcare records with data from all sources.
Revenue Cycle with Medical Documentation Both billing information and clinical information are collected from the patient and documented.
HIPPA protect private health information, ensure coverage, uncover fraud and abuse, and create industry standards
Clearinghouse Company that converts nonstandard transactions into standard transactions and transmits the data to health plans
who does a patients medical record belong to? Medical record belongs to the provider who created it
Breach impermissible use or disclosure of hippa that could pose significant risk to the affected person.
Fraud intentional deceptive act to obtain a benefit by taking advantage of another person
PHI individually identifiable health information transmitted or maintained by electronic media
Premium the amount a patient pays each amount to receive service.
Created by: trayona02
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