Ch. 1 OST 148 Key Terms + Review

Etiquette

standards of professional behavior

Fee for Service

payment method based on provider’s charges

CDHP

type of medical insurance combining a high-deductible health plan and a medical savings plan

Indemnity

health plan that protects beneficiaries against losses

EHR

a computerized lifelong healthcare record for an individual that incorporates data from all sources that provide treatment for the individual

Copayment

an amount that an insured person pays at the time of a visit to a provider

Certification

recognition of a superior level of skill by an official organization

HMO

an organization that contracts with a network of providers for the delivery of healthcare for a prepaid premium

Schedule of Benefits

a list of the medical services covered by an insurance policy

coinsurance

the percentage of each claim that an insured person must pay

PPO

a managed care network of providers under contract to provide services at discounted fees

compliance

actions that are performed to satisfy official requirements

self-funded (self-insured) health plans

a method by which organizations pay for health insurance directly and set up a fund from which to pay

Point of service plans are also called __

open HMOs

what type of insurance pays benefits and provides medical care for employees who are injured in job-related accidents

worker’s compensation insurance

step 6 of the revenue cycle is

checking out patients

a health plan that offers protection against loss is called an __ plan

indemnity

a payment method based on provider charges is called

fee for service

which type of health plan combines coverage of medical costs and delivery of healthcare for a prepaid premium to providers

health maintenance organization

a specified (fixed) amount that a beneficiary must pay at the time of a healthcare encounter is called a

copayment

step 1 in the revenue cycle is to

preregister patients

what type of insurance provides reimbursement for income lost due to an inability to work

disability insurance

how do insurance companies manage the risk that some individuals need very expensive medical services

they spread it among many policyholders

__ services are provided to keep patients healthy or prevent illness

preventive medical

a system combining the financing and delivery of healthcare services is called

managed care

MCO stands for

managed care organization

recognition of a superior level of skill by an official organization is called

certification

computer information systems that record, store, and manage patient information are known as

health information technology

accounting software used for scheduling appointments, billing, and financial record keeping is known as a

practice management program

a(n) __ is a computerized lifelong healthcare record that icorporates data from all sources that provide treatment for the individual

EHR

what does the use of an EHR system eliminate

the use of many paper forms

a practice management program and electronic health records combined into a single product is called an integrated __

PM/EHR

a healthcare plan that covers the cost of hospital and medical care is called __

medical insurance

excluded services are those that are

not covered in a medical insurance contract

which type of plan is usually bought by employers or organizations

group plan

__ is a fixed prepayment to a medical provider for services to a plan member for a specified period

capitation

a(n) is a managed care plan in which a network of providers supplies discounted treatment for plan members

PPO

what percentage of Americans had private plans according to a 2023 census bureau report

65.4 percent

step 3 of the revenue cycle is to

check in patients

some services require a(n) __from the payer before the service can be provided

prior authorization

it is important to verify codes with data from the patient’s __

medical record

where are providers’ fees for services located

on the fee schedule

step 8 of the revenue cycle is

monitoring payer adjudication

step 9 of the revenue cycle is to

generate patient statements

which of the following policies defines when bills have to be paid by patients in a medical practice

practice’s financial policy

where are payers’ payments applied to

appropriate patient accounts