means that your doctor, provider, or supplier must accept the Medicare-approved amount as full payment for covered services
this visit is available once every twelve months after the first twelve months of Part B coverage
the percentage you pay for covered services after you have met your deductible
a fixed amount one pays to receive a medical service, usually at the time of service
the amount one pays annually before the plan begins to pay. This does not apply to services that require a copay
is long lasting, used for a medical reason, and typically used in an individual's home
the plan contract that gives detailed information about the plan, including: what is and is not covered, what an individual pays, etc.
a monthly summary sent to an individual to let them know what services were billed, what was paid by whom, and what amount the individual is responsible to pay.
in this type of plan you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an urgent or emergency situation.
care that is usually given when an individual has decided that they no longer want care to cure terminal illness and/or one’s doctor has determined that efforts to cure an illness aren’t working.
a status for individuals starting when one is formally admitted to a hospital with a doctor’s order
a status for individuals getting emergency department services, observation services, surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit them to a hospital as an inpatient
in a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network
the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage
services to prevent illness or detect illness at an early stage
the doctor you see first for most health problems
a written order from a primary care doctor for a patient to see a specialist or get certain medical services, often required by HMOs
Advances in medicine reach the general public through the
These facilities are equipped to handle a broad range of medical needs, including emergency and surgical services
Unlike general hospitals, specialty hospitals limit their practices to a specific age or condition.
Federal, state, and local governments operate these hospitals.
This type of medical facility often is the home to research and educational programs
these facilities house elderly patients who can no longer live independently because of heath or other issues.
those that do not require a hospital stay
meaning illnesses that will be fatal
or care for the terminally ill, is also often delivered in the home.
controlling symptoms and making the person as comfortable as possible while allowing them to die with dignity.
is both a health service and health insurance.
. One of the largest government insurance programs is
especially among the elderly who are more likely to have health issues
the government also provides insurance for those who cannot afford it
are the professionals who administer the health care. They all work together to make sure that all aspects of the patient’s health are monitored.
the doctor patients see regularly to maintain overall health, is the leader of the team. These doctors are known as general practitioners, or family doctors,
these professionals acquire more education and skills than a registered nurse and can perform some services generally reserved for doctors.
These health professionals are responsible for filling prescriptions and dispensing medications.
the study of disease
the relationships between social and economic elements, also shape health services
The software we use to catch, track, and correct registration errors
Carson Tahoe’s Vice President and Chief Financial Officer
2010 US Federal Statute that overhauled insurance and healthcare law
The software CTH uses for document scanning, storage, and retrieval
The process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers
Carson Tahoe’s President and Chief Executive Officer
The online program that houses blank forms that CTH uses
The person who holds the ultimate financial responsibility for a patient’s visit
Department responsible for health information management and coding
Health Insurance Portability and Accountability Act of 1996
Team that verifies insurance plans and obtains pre-authorizations for upcoming exams and procedures
Health care program that assists low-income families or individuals in paying for long-term medical and custodial care costs
Federal insurance plan for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease
The software we use to determine Medical Necessity of exams and procedures for Medicare patients
The questionnaire that is completed during registration to determine if Medicare is the primary payer
A person receiving or registered to receive medical treatment
Department responsible for billing and collection
The program Patient Access uses to determine insurance eligibility and to obtain accurate insurance information
All departments that contribute to the capture, management, and collection of patient service revenue
The registration software used by CTH
What type of public health care agency is operated by the government?
The U.S. of health and human services is the official agency at what level?
Health activities that take place at the international level go through what organization?
Health care that provides a diverse range of medical services is called?
What is a one day surgical care center?
These provide follow up care to patients after hospitalization
A hospital that is dependent on gifts & donations as a source of revenue
The philosophy of this is to maintain comfort as death approaches
Places for people who are not candidates residing in a nursing home
Home with services that emphasizes privacy and choice
The monthly fee that a person must pay for health care insurance coverage
What takes place after an acute illness or injury?
Care that can be initiated at any stage of illness whether terminal or not
What is the need to hold costs within fixed limits?
Meets the health care needs of our veterans
What program is for adults ages 65 and older?
What program provides medical assistance for low income families?
Independent nonprofit organization that serves as an advisor to improve the nations health
Groups of drugs that have a different cost for each group.
the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan.
An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
A geographic area where a health insurance plan accepts members if it limits membership based on where people live.
A coverage rule used by some Medicare Prescription Drug Plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed drug.
A person who has health care insurance through the Medicare or Medicaid programs.
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services.
A written order from your primary care doctor for you to see a specialist or get certain medical services.
A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered.
An amount you may be required to pay as your share of the cost for services after you pay any deductibles.
An amount added to your monthly premium for Part B or a Medicare drug plan (Part D) if you don't join when you're first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions.
Approval that you must get from a Medicare drug plan before you fill your prescription in order for the prescription to be covered by your plan.
The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
A type of Medicare prescription drug coverage determination, a drug plan's decision to cover a drug that's not on its drug list or to waive a coverage rule
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
A complaint about the way your Medicare health plan or Medicare drug plan is giving care.
Health care that you get when you're admitted to a health care facility, like a hospital or skilled nursing facility.
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
A system of health care in which patients agree to visit only certain doctors and hospitals
The acronym for Health Maintenance Organization.
Also known as a primary care physician.
What is the amount you pay for health care services before your health insurance begins to pay?
A sum paid to cover money that has been spent or lost.
A federal law that is sometimes called the "privacy rule".
What type of claim form is used by a hospital?
Meaning of PPO.
Having inadequate insurance coverage.
The insured pays a share of payment made against a claim.
A federal system of health insurance for those requiring financial assistance.
Federal health insurance program for people 65 years or older.
A payment owed by the person insured at the time a covered service is rendered, covering part of the cost of the service.
Provides health care and financial protection.
M48.1 is an example of what type of code?
Organization paying for some serious treatments people need.
Subscription medical, less restrictive than HMO.
Focus solely on preventative care.
Government pays for all health cost.
Not covered by insurance.
Premium cost and medical expenses by health care plan.
Cost sharing in which the subscriber is responsible for a specific percentage of the cost of healthcare
(3 words) A Mercy program where the patient can receive a reduction in total costs as long as the account is over 45 days old
Fixed sum of money that the beneficiary must contribute towards the cost of their healthcare before insurance benefits begin
The person who is financially responsible for the account
Questionnaire to determine primary payor before Medicare
Meeting where coworker issues are resolved
Federal law requiring employers to permit employees to continue their group health insurance coverage after termination
Health Insurance _____________and Accountability Act
(2 words) Tool that utilizes fee schedules, payer contracts, and benefits to calculate a cost estimate
An insurance coverage that doesn't require authorization
Not to be disclosed
Collection and storage of patient demographic, insurance, and emergency information
(2 words) Balances patients may owe from previous visits
(2 words) Prior balances that have been turned over to collection agencies
Our Director's name
A U.S. law that creates a payroll tax requiring a deduction from the employees and employers.
Provides assistance to people with an inadequate or no income.
A program under the US Social Security Administration.
In an insurance policy that you have to pay out of pocket by the policyholder.
Choice of a high monthly payment and low deductible or high deductible and low monthly payment.
Insurance that pays for an employee's medical care in the event that he/she is injured at work.
type of vehicle, coverage needed, credit score, age, driving record, marital status
Payment by a United States agency to unemployed people.
payment made by a beneficiary (especially for health services) in addition to that made by an insurer.
Protection against financial loss that would result from the premature death of an insured.
Jointly funded by the states and the federal government.
Pays and benefits employees receive when they leave employment at a company.
Diagnostic Related Groups
open enrollment period
out of pocket
I can not take _______________ inside the Hospital.
What do the initials ePHI stand for electronically Protected Health _________ ?
Abbreviation for the Health Insurance Portability and Accountability Act of 1996?
Every patient has the right to ___________ with their medical treatment and conditions.
By law hospitals must train annually on HIPAA ____________.
Hospitals have ___________ and procedures to meet Federal HIPAA rules and regulations.
HIPAA security and privacy applies to everyone ______ in the facility.
HIPAA is governed by _____ and Human Services?
HIPAA was created with _____ standards for all patients.
Accessible __________ Health Information (PHI) is limited to only that information needed for performance of services.
Personally identifiable health information is protected by HIPAA includes photographic, electronic, spoken word and ______?
I may not post any identifiable information on______?
All information regarding patients must stay confidential. I can not even tell my friends or ____.
I may not share my computer log-in _____ with anyone.