Financial Practices Exam1

Fiscal year

Coordination of Benefits

UCR

Office Visit - CPT Book

Current Produral Terminology

International Classification of Diseases

Healthcare Common Procedure Coding System

Preferred Provider Organization; network together to offer discounts

Primary Care Physician

Health Maintenance Organization; usually require pre-authorization

Centers for Medicare and Medicaid Services

health insurance form

insurance for spouses and unmarried dependents of a veteran who is diabled or died or a service related injury

insurance for dependents of active duty and retired military personnel and dependents of those who died in active duty

Explanation of benefits

the percentage paid by the company or the insured

small payment required when seen by the provider

defines the period in which legal action can take place

procedures that are not medically necessary

the policy with the earliest effective date

determines whether a service or procedure is covered and if the insurance plan approves it as medically necessary

refers to separating the components of a procedure to increase reimbursement; fraudulent

instruction to the insurance company about whom and where to make payment

insurance designed to offset medical expenses of a catastrophic degree high deductible.

yes

80% of UCR after deductible

Anesthesia, surgery, pathology/lab, evaluation and management, radiology, medicine

Diagnostic and procedure

identifies the procedures performed, diagnoses, charges, and when to return.