Domain 5 Administrative Assisting

Premium

amount a policyholder pays monthly for health insurance coverage

Coinsurance

fixed percentage of charges that a patient pays after a deductible is met

NPI

number given by CMS to all providers

Allowed Charges

8. maximum amount a payer will pay a provider for a particular service or procedure

Medicare

federal health insurance for persons over age 65

RBRVS (Resource-Based Relative Value Scale)

payment system used by Medicare

CMS (The Centers for Medicare & Medicaid Services)

federal agency that administers Medicare and Medicaid programs

copayment

fixed fee paid by a patient for each visit

Medicaid

federal health cost assistance program for low income people

Exclusions

expenses not paid by an insurance carrier

Third Party Payer

numerical term for the insurance carrier

Deductible

fixed dollar amount that a patient must pay each year before an insurance company pays

Formulary

list of covered medications

CHIPS

health insurance program for uninsured children not eligible for Medicaid

PPO

managed care organization that allows "out of network" visits and self-referrals

EOB (explanation of benefits)

received by a patient and provider from an insurance company detailing allowed charges, amounts paid, etc.

CHAMPVA

health insurance for dependents of veterans with total & permanent service related disabilities

TRICARE

health insurance for families of active duty military personnel

Workers Compensation

insurance for employment related accidents and injuries

CPT

provides codes to document procedures and services in an outpatient setting

Capitation

fixed prepayment paid to a PCP for each patient enrolled in the practice

PCMH (patient centered medical home)

healthcare delivery model that is patient centered

S in SOAP

subjective data that comes directly from the pateint

A in SOAP

the diagnosis or impression of a patient's problem

O in SOAP

data that comes from examination results and from the physician

P in SOAP

includes treatment options, medications, etc, plan of action

Assignment of benefits

the authorization that directs an insurance carrier to pay the medical provider or medical practice directly

Correcting a medical record

draw a line through the original information so it is still legible

Patient Registration Form

contains Patient's demographic information, medical insurance information, emergency contact information and date

Tickler Files

date ordered reminder file used to avoid losing track of important dates

C in CHEDDAR

stands for chief complaint, presenting problems and subjective information

H in CHEDDAR

stands for medical history

Closed Files

files of patients who have died, moved away, or for some other reason no longer come to the office

Numeric Filing System

filing system used when the patients' names must be kept confidential

Coding

Putting an identifying mark or phrase on a document to ensure that it is placed in the correct file

Color-Coding

used when there is a need to distinguish files within a filing system

Shingling

method of filing paper medical reports involves placing newer reports on top of older reports

Preauthorization

request for approval for payment from a third-party payer prior to a procedure

Medicare Part A

Open-Hours Scheduling

walk-in system where there are few if any scheduled appointments; first come first serve; may be physician down time

Wave Scheduling

patients are scheduled to come in together; based on the reality that some patients will arrive late and others require more or less time with the practitioner

Cluster Scheduling

groups similar appointments together on a specific day or for a specific block of time

Medicare Part A

insurance that covers a patient that has been hospitalized up to 90 days for each benefit period