policyholder - Answers a person who buys an insurance plan, the insurer
health plan - Answers a plan, program, or organization that provides health benefits
premium - Answers the periodic amount of money the insurer pays to a health plan for insurance
coverage
payer - Answers private or government organizations that insures or pays for health care on the behalf
of beneficiaries
fee-for-service - Answers health plan that repays the policyholder for covered medical expenses
coinsurance - Answers part of charges that an insured person must pay for health care services after
payment of the deductible amount
managed care - Answers a type of insurance in which the carrier is responsible for both the financing
and the delivery of health care
capitation - Answers advance payment to a provider that covers each plan member's health care
services for a certain period of time
preferred provider organization (PPO) - Answers mananged care network of health care providers who
agree to perform services for plan members at discounted fees
health maintenance organization (HMO) - Answers a managed health care system in which providers
agree to offer health care to the organization's members for fixed periodic payments from the plan
copayment - Answers a small fixed fee paid by the patient at the time of an office visit
encounter form - Answers list of the procedures and charges for a patient's visit
diagnosis code - Answers standardized value that represents a patient's illness, signs, and symptoms
procedure code - Answers a code that identifies a medical service
remittance advice (RA) - Answers explanation of benefits transmitted electronically by a payer to a
provider
explanantion of benefits (EOB) - Answers paper document from a payer that shows how the amount of a
benefit was determined
accounting cycle - Answers flow of financial transactions in a business
accounts receivable - Answers monies that are flowing into a business
, patient information form - Answers document that contains personal, employment, and medical
insurance information about a patient
audit/edit report - Answers report that lists error in a claim
protected health information (PHI) - Answers information about a patient's past, present, or future
physical or mental health or payment for health care that can be used to identify the person
clearinghouse - Answers organization that receives claims from a provider, checks and prepares them
for processing
electronic prescribing - Answers use of computer and handheld devices to write and transmit
prescriptions to a pharmacy in a secure format
national provider identifer (NPI) - Answers national standard identifier for all health care providers
consisting of ten numbers
electronic data interchange (EDI) - Answers transfer of business transactions from one computer to
another using communications protocols
practice management program (PMP) - Answers software program that automates many of the
administrative and finacial tasks required to run a medical practice
electronic medical records (EMR) - Answers electronic collection and management of health information
HIPAA Security rule - Answers regulations outlining the minimum safeguards required to prevent
unauthorized access to electronic health care information
HIPAA Electronic Transaction and Code Set standards - Answers regulations that require electronic
transactions to usse standardized formats
information technology (IT) - Answers computer harware and software systems
walkout statement - Answers document listing charges and payments that is given to a patient after an
office visit
X12-837 Health Care Claim (837P) - Answers electronic format of the claim used by physicians' offices to
bill for services
backup data - Answers copy of data files made at a specific point in time that can be used to restore data
to the system
knowledge base - Answers searchable collection of up-to-date technical information
MMDDCCYY format - Answers way in which dates must be keyed
packing data - Answers deletion of vacant slots from the database