Paper on Medical Insurance Terms

Part A: Complete the following table by defining each of the terms in the table. Be clear and concise, use complete sentences, and define the terms in your own words.

Accounts Receivable (AR) - Money owed to from customer to a medical practice

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Accounts Payable (AP) - Money owed by a company to its suppliers for operating expenses

Capitation - Payment for clinical service where a physician or an institutional provider is paid a fixed, per capita amount

Electronic Health Record (EHR) - A computer system that allows facilities, doctors and hospitals to track the patients health information instead of using papers

Encounter Form - Components used for accurate collections and billings,

Health Information Exchange (HIE) - This system ensures availability of health records regardless of the facility the patient visits.

Health Information Technology (HIT) - This system allows access of information of a patient no matter the facility the patient chooses to visit.

Diagnosis Code - Letters and numbers used when keying in patients diagnosis. They include description of illness, injuries and diseases

Explanation of Benefits - A statement circulated to individuals under insurance cover plan to explain the services that were paid for.

Indemnity - This is usually higher deductible insurance that allows the patient to choose the facility they want to visit.

Personal Health Record (PHR) - These are records maintained by patients to keep their personal health records and information.

Practice Management Program (PMP) - Works as an interlink between health care management and business administration

Protected Health Information (PHI) - Confidential health information gathered by the provider to properly and appropriately take care of the patients

Remittance Advice (RA) - A notice sent out to the contractors, physicians, suppliers informing them that they have received payment.

Revenue Cycle Management (RCM) - This is a system that allows healthcare facilities to track patients right from registration, appointment reservation and balance clearance.

NPI numbers - It is part of HIPPA administrative standard. This is an identification number that is unique for each facility.

Place of Service Codes - Codes specific for health care professional claims to show that the service was rendered.

Secondary Insurance - The second insurance in a case where a person is covered with more than one insurance plan.

Birthday Rule - This is a claim health insurance companies use when a child is listed as dependent on both parents group health cover.

Primary Insurance - This is the insurance used first when billing patients.

Part B: Write 150- to 350-word response to the following question. Be clear and concise, use complete sentences, and explain your answers using specific examples.

Explain why, in terms of job performance and efficiency, knowing medical billing terms is critical for working in the health care field. Explain situations where encounter forms should be reviewed with the physician.

It is important to know the medical billing terms. Knowledge of the terms is crucial in maintained of a proper record, efficient flow of work and, constant updating of the records. Medical billing terms and codes also ensure that the patients receive the much needed health services while in turn the providers get a timely compensation. Updating the codes annually ensures that minimal errors occur and give room for changes in the internal system. It is possible to achieve great efficiency when there is a lot of knowledge on the billing process. In an incident when an error occurs, the patient, provider or the insurance may lose resources in ways that could be avoided. Patients can end up paying in errors where the patients are coded for services that are not catered for by the insurance. From this discussion, it can be concluded that mastery of medical billing terminologies is prudent for efficiency and effectiveness in medical billing.

References

Medical Dictionary. (n.d). Retrieved from http://www.medicaldictionary.com

University of Phoenix. (2016). Weekly Overview. Retrieved from University of Phoenix, HCR/201 website.

University of Phoenix. (2016). Medical Insurance: An Integrated Claims Process Approach (6th ed) Chapter 1. Retrieved from University of Phoenix, HCR/201 website.