| Capitation- A fixed amount of money, per capita amount for each patient enrolled over a stated period of time, paid to a health plan or doctor (regardless of the type and number of services provided). This is used to cover the cost of a health plan member''''''''s health care services for a certain length of time. |
| Cardiology Charges- Charges for heart procedures. Examples are heart catheterization and stress testing. |
| Case Management- A way to help you get the care you need, especially when you need pre-authorized care from several services. Usually a nurse helps arrange for your care. |
| CCR - Continuity Care Record- In an electronic medical records system, the minimum clinical and demographic data that a physician needs to make informed medical decisions. |
| Centers for Medicare and Medicaid (CMS)- The federal agency that runs the Medicare program. In addition, CMS works with the States to run the Medicaid program. CMS works to make sure that the beneficiaries in these programs are able to get high quality health care. |
| CHAMPUS- Insurance linked to military service. |
| CHR - Computerized Health Record- Term synonymous with Electronic Medical Record (EMR). |
| Charity Care- Free or reduced-fee care for patients who have financial hardship. |
| Claim- Your medical bill that is sent to an insurance company for processing. |
| Claim Control Number- A number assigned by the Medi-Cal fiscal intermediary on a Treatment Authorization Request and used for reference when processing the request. |
| Claim Number- A number given to a medical service. |
| Claims Inquiry Form (CIF)- A Medi-Cal form used for tracing a claim, resubmitting a claim after a denial, or when requesting an adjustment for underpaid or overpaid claims. |
| Clean Claim- A claim that does not have to be investigated by insurance companies before they process it. |
| Clearinghouse- A company that, for a fee, electronically receives batches of claims from providers or billing centers in a single format, reformats the claims data according to the software requirements of the indicated insurance carriers or governmental agencies, and retransmits the data electronically to those designated payers. There is a contractual financial relationship between the clearinghouse and the payer. The electronic claims are edited upon arrival at the clearinghouse terminal. A report is issued describing on the requirements of the ultimate payer. |
| Clinic- An area in a hospital or separate building that treats walk-in patients for non-emergency care. |
| CMS 1500 - The new claim form which includes the provider and group NPI number. |
| COBRA Insurance- Health insurance that you can buy when you lose your job. It is generally more expensive than insurance provided through your job but less expensive than insurance purchased on your own when you are unemployed. |
| Coding- A system whereby a numerical code is applied to medical descriptions of diagnoses, procedures, pharmaceutical elements, and durable medical equipment. These numerical descriptions permit easy accounting procedures for statistical classification. |
| Coding of Claims- Translating diagnoses and procedures in your medical record into numbers that computers can understand. |
| Coinsurance- A fixed percentage of the total amount paid for a health care service that can be charged to a beneficiary on a per service basis. |
| Coinsurance Days (Medicare)- Hospital Inpatient Medicare coverage from day 61 to day 90 of continuous hospitalization. You are responsible for paying for part of those days. After the 90th day, you enter your "Lifetime Reserve Days." |
| Collection Agency- A business that collects money for unpaid bills. |
| Collection ratio- The relationship between the amount of money owed and the amount the money collected in reference to the doctor''''''''s accounts receivable. |
| Consent (for treatment)- An agreement you sign that gives your permission to receive medical services or treatment from doctors or hospitals. |
| Contractual Adjustment- A part of the bill that the doctor or hospital must write off (not charge the patient) because of billing agreements with his/her insurance company. |
| Coordination of Benefits (COB)- A way to decide which insurance company is responsible for payment if you have more than one insurance plan. |
| CPOE - Computerized Physician Order Entry- Software in medical records and billing systems for ordering tests, treatments or medications from another computer on a network. Orders are transferred to a lab, pharmacy, or other medical unit. |
| CPR - Computerized Patient Record- Term synonymous with Electronic Medical Record (EMR). |
| Copayment- A copayment is usually a specified flat amount you pay for a service (e.g., $10 per visit, $25 per inpatient hospital day), with the insurer paying the balance. Also referred to as coinsurance. |
| Coronary Care- Routine charges for care you receive in a heart center because you need more care than you can get in a regular medical unit. |
| Covered Benefit- A health service or item that is included in your health plan, and that is paid for either partially or fully. |
| Covered Days- Days that your insurance company pays for in full or in part. |
| CPT Codes- A coding system used to describe what treatment or services were given to you by your doctor. |
| Crossover Claim- Bill for services rendered to a patient receiving benefits simultaneously from Medicare and Medicaid. |
| CT Scan- A type of X-ray of the head or body; usually done in a hospital''''''''s x-ray department. |
