terms
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each of the black spaces below before clicking
on it to display the answer.
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| buffing | a physicians justifying the transference of sick, high-cost patients to other physicians in a managed care plan
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| capitation | a system of payment used by managed care plans in which physicians and hospitals are paid a fixed per capita amount for each patient enrolled over a stated period of time
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| carve outs | medical services not included within the capitation rate of a managed care contract and may be contracted seperately
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| churning | when pysicians see a high volume of patients more then medical necessary to increase revenue
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| copayment | a patients payment of a portion of the cost at the time of service is rendered
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| deductible | a specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins converting health care costs
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| direct referral | authorization request form is completed and signed by the physican and handed to the patient to be done directly
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| gatekeeper | in a managed care system, this is the physicans who controls the patients access to speacialists and diagnostic services
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| particippating physician | a physician who contracts with an HMO or other insurance company to provide services who have agreed to accept a plan payment
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| tertiary | services requested by a specialist from another specialist
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| v codes | health care encounters that occur for reasons other than illness or injury
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| e codes |
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