CCMA Review - Glossary Flashcards

subjective information

information felt, experienced, or described by the patient

objective information

information that can be directly measured such as vital signs

pyrexia

medical term for fever

anthropometric measurement

physical measurements of the human body used to assess health

diagnosis code, ICD

a standardized code identifyinf the patients condition or reason for testingpe

epstein-barr virus

a virus caused by mononucleosis

H. pylori

a bacteria associated with stomach ulcers

advance directive

a legal document stating wishes for medical care and end of life decisions if unable to communicate

cluster scheduling

grouping similar appointment types into the same time blocks

scheduled matrix

a pre-built template defining provider availability

insurance premium

the fixed monthly amount paid to maintain insurance coverage

copayment

a fixed dollar amount the patient pays at each visit

deductible

the amount a patient pays out-of-pocket before insurance begins to pay

coinsurance

the persentage of costs the patient pays after a deductible is met

sliding scale fee

insurance fees adjusted based on patient income level

precertification

verifying that a patients insurance plan includes a specific benefit.

utilization review

insurance evaluation of the medical necessity of proposed services

predetermination

submitting a treatment plan to the payer in advance for a coverage estimate

CPT codes

5-digit codes for medical procedures

superbill/encounter form

document listing visit diagnoses and procedures with codes.

ICD-10-PCS

procedure codes for inpatient hospital procedures

accounts recivable A/R

total money owed for service but not yet payed

A/R Aging Report

groups outstanding balances by time unpaid to prioritize collection

clearinghouse

third party that checks diagnosis/procedure codes for errors

advanced beneficiary notice

medicare notifying a patient a servace may not be covered

CMS

centers for medicare and medicade services - oversees medicare and documentation guidelines

MACRA

2015 law shifting Medicare towards value based payment