NHA Medical Terms

abandonment

abandonment

Discontinuing medical care without giving the proper notice or providing a competent replacement

active files

Section of medical charts for patients currently and receiving treatment (becomes inactive when someone dies)

Advance Beneficiary Notice of Noncoverage (ABN)

Form provided to a patient if a provider believe that a service may be declined because Medicare might consider it unnecessary (ONLY for medicare patients)

advance directive form

Document that spells out what kind of treatment a patient wants in the event that he can’t speak for himself. Also known as living will.

allowable amount

The limit that most insurance plans put on the amount that will be allowed for reimbursement for a service or procedure

assignment of benefits (AOB) form

Form that authorizes health insurance benefits to be sent directly to providers

birthday rule

The health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan

Blue Cross and Blue Shield plan (BCBS)

The first prepaid plan in the U.S. that offers health insurance to individuals, small businesses, seniors, and large employer groups

certified mail

First class mail that also gives the mail added protection by offering insurance tracking, and return receipt options

copayment

A fixed fee for a service or medication, usually collected at the time of service or purchase (primary - less, specialist - more)

covered entities

Providers, hospitals, laboratories facilities, nursing homes, rehabilitation facilities, health plans, health care clearinghouses, and those that supply care, services, or supplies to a patient and transmit any health information electronically (any facility that provides service to any patient)

deductible

Amount a patient must pay before insurance pays anything

electronic health record (EHR)

Electronic record of health related info about patient that conforms to nationally recognized interoperability standards that can be created, managed, and reviewed by authorized providers and staff from more than one health care organization (You can transfer these records to any facility)

electronic medical record (EMR)

An electronic record of health info that is created, added to, managed, and reviewed by authorized providers and staff within a single health care organization (Only shared with those in a certain facility)

emancipated minor

A person younger than the age of majority (usually 18 to 21 years of age) who is married, in the armed forces, living apart from parents or a guardian, or self-supporting

explanation of benefits (EOB)

A record of a patient’s fees (goes to patient, also goes to doctor but under a different name)

guarantor

Person or entity responsible for the remaining payment of services after insurance has paid

health history form

Form that asks patients to list any illnesses or surgeries they have had, family history, medications taken, chronic health issues, allergies, and other physicians they consulted

Health Insurance Portability and Accountability Act (HIPAA) of 1996

Protect the privacy and security of patient information

health maintenance organization (HMO)

Plan that allows patients to only go to physicians, other health care professionals, or hospitals on a list of approved providers, except in an emergency

implied consent

Patient presents for treatment (i.e. extending arm to allow venipuncture to happen), someone else feels like the person should receive medical help (i.e. giving consent to help out a passed out person)

inactive files

Section of medical charts for patients the provider has not seen for 6 months or longer

incidental disclosure

Secondary use of PHI (protected health info) that cannot be reasonably prevented, is limited in nature, and occurs as a result of another use or disclosure that is permitted

informed consent

Providers explain medical or diagnostic procedures, surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask questions and consent before medical intervention is provided

advanced directive form

Document that spells out what kind of treatment a patient wants in the event that he can’t speak for himself. Also known as living will.

matrix

A grid with time slots blocked out when physicians are unavailable oro the office is closed.

Medicaid

A government based health insurance option that pays for medical assistance for individuals who have low incomes and limited financial resources. Funded at the state and national level. Administered at the state level.

Medicare

Federally funded health insurance provided to people age 65 and older, people younger than 65 who have certain disabilities, and people of all ages with end-stage kidney disease.

Medicare Part A

Provides hospitalization insurance to eligible individuals.

Medicare Part B

Voluntary supplemental medical insurance to help pay for physicians’ and other medical professionals’ services, medical services, and medical-surgical supplies not covered by Medicare Part A.

Medicare Part C

Combination of Medicare Part A and B

Medicare Part D

A plan run by private insurance companies and other vendors approved by Medicare to cover the cost of approved prescriptions.

National Provider Identifier (NPI)

Unique 10-digit code for providers required by HIPAA

Notice of Privacy Practices

Document informing a patient of when and how their PHI can be used

Occupational Safety and Health Administration

Part of the U.S. Department of Labor with the mission to ensure workplace safety and a healthy working environment

petty cash fund

A small amount of cash available for expenses such as postage, parking fees, small contributions, emergency supplies, and miscellaneous small items

preauthorization

Formal approval from the insurance company that it will cover the test or procedure

preferred provider organization (PPO)

Plan that allows patients to use physicians, specialists, and hospitals in the plan’s network and receive a greater discount on services

premium

A pre-established amount set by the insurance company and paid regularly, usually on a monthly basis, by the patient or an employer

protected health information (PHI)

Information about health status or health care that can be linked to a specific individual

regular referral

When a physician decides that a patient needs to see a specialist

stat referral

Needed in an emergency situation, and can be approved immediately over the telephone after the utilization review has approved the faxed document

urgent referral

When an urgent, but not life-threatening, situation occurs, requiring that the referral be taken care of quickly