OTEC 1175 Unit 2 Terminology

2. A manage care plan that requires a fixed payment at each office visit.
6. Some insurance plans pay a percentage of an approve amount of the fees after the deductible has been paid. Typically 80/20 where 80percent is paid by the insurance company and 20 percent is paid by the patient, the 20 percent is co-insurance.
10. A service that facilitates the movement of electronic claims from the medical office to the insurance companies. The claims are edited and validated to ensure accuracy.
11. Amounts that are taken away from (or added to) the balance of an account. Adjustment are often used to reflect accounting situations.
13. Out-of-pocket expense that patient must pay before the insurance company will pay for covered services. Usually begins at the beginning of the year January 1.
15. Services not covered by a health plan.

1. Also referred to as the clinical area, or that part of the office where health care professionals examine patients.
3. Also referred to as the administrative area, is the hub of the medical facility.
4. Those individuals who have not received services from the physician or an associate physician of the same group within the same specialty, within the past three years.
5. The person responsible for paying medical expenses, usually the patient.
7. International Classification of Diseases codes used to identify patients diagnosis.
8. An individual who has received professional services from a physician within the past three years, or from another physician of the same specialty who belongs to the same group practice.
9. Source document that include the notes written in the patient’s record also known as Encounter form, charge ticket, fee slip or visit slip.
12. 1996 Protection of patient health information. Ensures that individuals have an opportunity to keep their health insurance when they leave an employer. Major focus is on security and privacy of health information.
14. Current Procedural Terminology codes that identify procedures performed for patients.