Professional Billing Concepts
Terms
undefined, object
copy deck
- COPAY
- Copay: Provision requiring policyholder to pay to a provider for each visit or service received.
- COINSURANCE
- Coinsurance: Percentage paid for covered services after deductible and the copayment paid.
- CMS-1500
- CMS-1500: Form used to submit Medicare claims; previously called the HCFA-1500
- FEE SCHEDULE
- List of predetermined payments for health care services provided to patients (e.g. a fee is assigned to each CPT code)
- HCFA-1500
- Now called the CMS-1500. Please see the definition for CMS-1500.
- HEALTH CARE
- Illnesses, injuries and medical concerns, but also include preventative services.
- MEDICAL CARE
- Identification of diseases, provision of care & treatment as provided by health providers to those who are sick, injured, or concerned health status.
- LIEN
- The right to take and hold or sell the property of a debtor as security or payment for a debt or duty.
- SUBROGATION
- The substitution of one person for another, especially the legal doctrine of substituting one creditor for another.
- MINIMUM DATA SET
- Data elements collected by long-term care facilities.
-
HEALTH MAINTENANCE ORGANIZATION
(HMO) - Responsible for providing health care services to subscribers in a given geographical area for a fixed fee.
- BASE PERIOD
- Period of time that usually covers 12 months and is divided into 4 consecutive quarters.
- Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
-
CHAMPVA: Healthcare benefits for dependents of veterans:
A) rated as 100% permanently and totally disabled due to service-related conditions
B) veterans who died in service-related conditions
C) and veterans who died on duty with less than 30 days of active service. -
Civilian Health and Medical Program - Uniformed Services
(CHAMPUS) -
CHAMPUS:
A) Now known as TRICARE.
B) Benefits for dependents of those serving in armed forces and uniformed branches of the Public Health Service and the National Oceanic and Atmospheric Administration - DEDUCTIBLE
- Amount for which the patient is financially responsible before an insurance agency provides coverage.