Medical Terminology
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| show | a policy holder and an insurance carrier
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| show | a group of employees and their dependents are insured under 1 group policy issued to the employer
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| personal insurance | show 🗑
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| show | pre-determined set of benefits covered under one set annual fee
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| health maintenance organization (HMO) | show 🗑
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| show | like a HMO, but more flexiable - pay higher premiums - no primary care physician
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| show | managed care plan that gives beneficiaries the option whom to see for services.
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| Medicare Part A | show 🗑
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| Medicare Part B | show 🗑
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| Medicare Part D | show 🗑
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| advance beneficiary notice | show 🗑
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| show | this covers medical services that medicare denies (coinsurance)
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| blue cross | show 🗑
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| blue shield | show 🗑
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| show | reimbursement is directly sent from payer to the provider
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| show | the provider agrees to accept what the insurance company approves as payment in full
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| show | a fee that is charged for each procedure or service performed by the physician
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| show | an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area
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| show | the cost of insurance coverage
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| deductible | show 🗑
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| coinsurance | show 🗑
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| co-payment | show 🗑
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| coding | show 🗑
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| show | conditions, situations and services NOT covered by the insurance
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| pre-certification | show 🗑
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| pre-authorization | show 🗑
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| show | a working diagnosis which is not yet established
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| eligibility | show 🗑
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| show | when 2 insurance companies work together to coordinate payment of the benefits
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| peer review organization (PRO) | show 🗑
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| show | law passed by the federal government to prosecute cases of medicaid fraud
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| show | an electronic or paper-based report of payment by the payer to the provider
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| patient's bill of rights | show 🗑
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