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administrative management


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health plan
a plan, program, or organization that provides health benefits.
procedure code
a code that identifies a medical service.
medical coder
a person who analyzes and codes patient diagnoses, procedures, and symptoms.
diagnosis code
a standardized value that represents a patient's illness, signs, and symptoms.
health plan that repays the policyholder for covered medical expenses.
a two digit character that is appended to a CPT code to report special circumstances involved with a procedure or service.
patient information form
form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim.
accounts receivable
monies that are flowing into a business.
remittance advice
an explanation of benefits transmitted electronically by a payer to a provider.
managed care
a type of insurance in which the carrier is responsible for both the financing and the delivery of health care.
the periodic amount of money the insured pays to a health plan for insurance coverage.
advance payment to a provider that covers each plan member's health care services for a certain period of time.
a small fixed fee paid by the patient at the time of an office visit.
consumer driven health plan
a type of managed care in which a high deductible low premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit.
a person who buys an insurance plan; the insured.
billing cycle
regular schedule of sending statements to patients.
the process of assigning standardized codes to diagnoses and procedures.
practice management program
a software program that automates many of the administrative and financial tasks required to run a medical practice.
a list of all services performed for a patient, along with the charges for each service.
private or government organization that insures or pays for health care on the behalf of beneficiaries.
preferred provider organization
managed care network of health care providers who agree to perform services for plan members at discounted fees.
series of steps that determine whether a claim should be paid.
explanation of benefits
paper document from a payer that shows how the amount of a benefit was determined.
medical necessity
treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and provided in accordance with generally accepted standards of medical practice.
health maintenance organization
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.
part of charges that an insured person must pay for health care services after payment of the deductible amount.
physician's opinion of the nature of the patient's illness or injury.
accounting cycle
the flow of financial transactions in a business.
encounter form
a list of the procedures and charges for a patient's visit.
medical treatment provided by a physician or other health care provider.

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