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2, 12, 13 UHI

vocab

TermDefinition
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