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2, 12, 13 UHI
vocab
| Term | Definition |
|---|---|
| medicare | reimburses health care services to Americans over the age of 65 |
| supplemental plan | covers the deductible and copay or coinsurance of a primary health insurance policy |
| meaningful use | objectives and measures that achieve goals of improved patient care outcomes and delivery through data capture and sharing, advance clinical processes. |
| accountable care organization | a recognized legal entity under state law that in comprised of a group of ACO participants |
| preventive services | designed to help individuals avoid problems with health and injuries |
| diagnosis related groups | prospective payment system that reimburses hospitals for inpatient stays |
| health insurance market | method American will use to purchase health coverage that fits their budget and needs |
| commercial health insurance | covers the medical expenses of individual groups; premiums and benefits vary according to the type of plan offered. |
| co-payment | provision in an insurance policy that requires the policy holder or patient to pay a specific dollar amount to a health care provider for each visit or medical service received |
| co-insurance | set percentage that a patient owes for covered medical services (after deductible is met and copayment is paid) |
| deductible | amount for which that patient is financially responsible for before an insurance policy provides coverage |
| 3rd party administrator | company that provides health benefit claim administration and other outsourcing services for self-insured companies |
| precertification | requires pre-authorization of outpatient physical, occupational, and speech therapy services. |
| insurance fee schedule | list of predetermined payments for health care services provided to patients |
| PAR | participating provider - contracts with health insurance plans and accepts whatever the plan pays for procedures and services performed, cheapest route for services |
| non-PAR | non-participating providers - does not contract with the insurance plan; patients who elect to receive care from non-PARs will incur higher out-of-pocket payments. |
| brithday rule | states that the policyholder whore birth month and day occurs earliest in the year remains the primary insurance holder for dependent children, YEAR OF BIRTH DOES NOT PLAY A ROLE IN THIS. |
| ICD-10 | general coding rules that apply to the assignment of codes, for diagnosis. |
| CPT | used to assigned procedural codes |
| indemnity insurance | compensates policy holders for actual economic losses, requires proof of losses (ex., aflac) |
| liability insurance | policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on the premises owned by the insured |
| medicare A | reimburses institutional providers for inpatient and hospice services. |
| medicare B | reimburses for outpatient services |
| medicare C | extra coverage, resulting in lower out of pocket expenses and prescriptions |
| medicare D | covers prescriptions once the coverage limit is surpassed |
Created by:
Mika42016
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