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
An established schedule of fees set for services performed by providers and paid by the patient
protection in return for periodic premium payments that provides reimbursement of expenses resulting from illness or injury
the sum of money paid at the time of medical service; it is a form of coinsurance
provision frequently is found in medical insurance policies whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio
Civilian Health and Medical Program of the Veterans Administration known as
states that when an individual is covered under two insurance policies, the insurance plan of the policyholder whose birthday comes ﬁrst in the calendar year (month and day, not year) becomes the primary insurance.
A term used in managed care for an approved referral
a payment method used by many managed care organizations in which a ﬁxed amount of money is reimbursed to the provider for patients enrolled during a speciﬁc period of time, no matter what services were received or how many visits were made.
a letter or statement from Medicare that describes what was paid, denied, or reduced in payment.
Pays expenses involved in the care of the teeth and gums
Protects a person in the event of a certain type of accident, such as an airplane crash
Often includes benefits for medical expenses payable to individuals who are injured in the insured person’s home or during an automobile accident
Covers a continuum of maintenance and health services for chronically ill, disabled, or mentally retarded individuals
Provides payment of a specified amount on the insured’s death
Pays the cost of all or part of the insured person’s hospital room and board and specific hospital services
a review of individual cases by a committee to make sure services are medically necessary and to study how providers use medical care resources
40. An insurance term used when a primary care provider wants to send a patient to a specialist
periodic (monthly, quarterly, or annual) payment of a specific sum of money to an insurance company for which the insurer, in return, agrees to provide certain benefits
person who pays a premium to an insurance company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance
a general practice or nonspecialist provider or physician responsible for the care of a patient for some health maintenance organizations
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
position requires employee to have goo medical terminology and administrative skills
with addition training in the ophthalmic field medical assitant can become a
provides basic nursing care to patients in nursing and retirement homes
lab tech who specializes in the formation,structure and function of cells
clerical and chairside assistant of dentists
provides special training to perform dental services including radiology, apply meds and patient education
skilled in performing EKGs in clinic/hospital settings
also know n as a medical technologist works under the supervision of a pathologist
trained to work in physician offices on both th clinical and admin side
professional nurse who completed a nursing program and passed examination
professional nurse with extensive training in labor and delivery
Registered nurse with a masters degree who works under the supervison of a physician
has basic nursing skills and commonly work in hospitals and nursing homes
specialized training in nutritional management
has associate degree and works under the supervision of a Registered Occupational Therapist
assist licensed pharmacist in preparing medications
extensive training in drawing blood from veins
trained in certain aspects of the practice to provide assistance; under direct supervision of physician
training in radiology procedures; assist radiologist
performs routine clerical, communication and reception tasks in a hospital setting
A contract with a company where the subscriber pays a regular premium in exchange for a defined set of benefits
Reffered to as family doctor/PCP this person administers routine and preventive care, and makes referrals for specialty services when needed.
A provider who focuses on one area of medicine. Like a cardiologist or neurologist
A contracted, pre-determined dollar amount insurance company requires a patient to pay for a particular medical service. (It requires patients to pay a small amount upfront to deter people from seeking medical care that may not be necessary.)
The contracted rate a health insurance company will pay toward a specific medical service.
A contracted, pre-determined percentage of the allowable charge that a patient is required to pay for a particular medical service (after the deductible is met and before the out-of-pocket maximum is met).
A pre-determined annual amount patient must pay before insurance begins to cover.
Annual maximum amount patient is required to pay for in-network medical services per his/her insurance plan contract (typically, copay + coins + deductible)
The person who is responsible for payment of the monthly premium, or whose employment is the basis for the coverage.
A person entitled to health insurance benefits under the subscriber’s plan.
A specific package of benefits negotiated between the company and the employer.
Dates during which the insurance plan is active.
Explanation of Benefits is a statement from the insurance company that details payments and adjustments made for services. EOBs go to both the provider and the patient.
/Response from the insurance company that states no payment will be made. (service could be not covered by the insurance plan, or the insurance company may need more information.)
The order in which the claim is sent to insurance companies. If patient has more than one insurance plan, we must determine which insurance should be billed primary, secondary, etc. Primary: the first insurance company designated to pay toward their allowable charges. Secondary: the second insurance company designated to pay toward their allowable charges.
The pathway a patient takes from one provider to another. Referrals may be required by insurance before a patient can be seen by the other provider.
The process whereby a physician must obtain insurance approval before a patient receives certain treatment or drugs (study, test, procedure, surgery.)
National Provider Identification
The note received from the insurance company after getting medical services from a doctor or hospital. It tells what was billed, the payment amount approved or denied by the insurance, the amount paid, and what the patient must pay.
Portion of the bill, as defined by the insurance company which the patient owes.
Advanced Beneficiary Notice
A person or persons whose account that has been sent to a collection agency for further action.
The cost sharing part of the bill that the patients have to pay.
A part of the bill that we must write off because of billing agreements with insurance companies.
A cost sharing part of the bill that is the patient’s responsibility to pay.
A coding system used to describe what treatment or services were given to the patient by their provider. Used for hospital outpatient services billed on an UB and professional services billed on HCFA 1500s
How much cost sharing that the patient must pay for medical services often before their insurance starts to pay.
A code used for billing that describes the patient’s condition. Also called ICD-10 diagnosis code.
Individual who is responsibility for the bill.
Patient class in which the patient requires a higher degree of nursing and physician care.
A person who is a policyholder of the insurance. Also known as the subscriber, policyholder, cardholder, or beneficiary.
Type of service used by doctors and hospitals to decide whether a patient needs inpatient hospital care or whether they can recover at home or in an outpatient area. Usually charged by the hour.
Any service received at a hospital or clinic that is not an inpatient status. Includes Emergence Room, Observation, and ancillary services.
A form used by hospitals to file insurance claims for medical services. Used when billing for hospital technical services.
Part of medicare that helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
Part of Medicare that usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
Claim form used by doctors to file insurance claims for medical services. Used when billing for professional services.
Medicare Secondary Questionnaire
Hospital Billing (abv)
Professional Billing (abv)
After a patient is discharged from, the account status is changes from Open to
A holding tank for accounts that we have identified has issues or needs follow up performed
Hospital Clinic System used by WVUH
What does the acronym PPO stand for?
What is the acronym for Health Maintenance Organization?
There are two types of medical billing: Institutional and _______________________.
An __________ is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
What type of claim form is used by hospitals?
Another name for a Health Information Specialist is a _________________________ Specialist.
An _____________________________ is a digital version of the traditional paper-based medical record for an individual. The EMR represents a medical record within a single facility, such as a doctor's office or a clinic.
What is the amount you pay for health care services before your health insurance begins to pay?
A __________ is a fixed amount you pay for a health care service?
A primary care physician is also known as a _______________________.
What is the abbreviation for out-of-network?
What is the abbreviation for in-network?
What type of managed care plan lets you choose between an HMO or a PPO each time you need care?
How many parts does Medicare have?
A 1996 federal law that is sometimes called the "privacy rule", outlining how certain entities can use or disclose personal health information.
The reason for the visit or surgery that defines the disease process or injury.
M48.1 is an example of what type of code?
What does UB stand for in UB-04?
The healthcare system, funded by the U.S. Department of Defense, that active and retired military and their dependents use.
The entity that reimburses the provider for services. Insurance companies, Medicare, Medicaid, and third-party administrators are all payers in the healthcare industry.
Any health care plan, provider, or service that transmits health care information in an electronic form and is thereby governed by laws and regulations in the handling of such data. It's called a covered _______________?
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.
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
The emphasis of the health care industry is shifting from managing illness to managing health of a community and the environment
What type of care describes a variety of health, personal, and social services provided over a prolonged period
Type of care that is a service that provides short-term relief or “time off” for people providing home care to people that are ill, disabled, or frail
Health services that are provided in the patients place of residence
Health care services in which patients who are recovering from illness or disability receive rehabilitation and supportive care
Federally funded national health insurance program for people over 65 years of age in the U.S.
Facility that offers skilled care from a licensed nursing staff
Is a caring discipline
Is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness
What health service model shows that population based health care services provide the basis for preventive services
Examines eyes for vision problems and defects
Provides total patient care by assessing a patients condition, administering medications, dressing changes, starting IVs, giving blood and other treatments
Doctors who specialize in the care of the teeth and mouth
A person who is responsible for the planning of individual therapeutic meals to help promote healing
Relating to or using the methods or principles of science
A physician specialty who specializes in the diagnosis of diseases and infections by examining cells, tissues, and body fluids of patients
Provde a therapeutic environment for the delivery of health care
An individual awaiting or under medical care and treatment
Create a picture of patient health status at a single point in time
The common name for a physician: a person skilled in the healing arts
A scientist that studies human genes
Manintain or change the health status of the patient over time
Use scientific and technical advancements to enhance diagnostic and therapeutic abilities in health care
Provide functions that support and document patient care
Also called heart beat
A person who dispenses and suggests medications to be used in the treatment of diseases and disorders
Tools you use for a specific task