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wk 3 terms/acronyms

continuity of care documenting patient care services so that others who treat the patient have a source of information on which to base additional care and treatment
copayment provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service recieved
deductible amount for which the patient is financially responsible before an insurance policy provides coverage
Fee schedule list of predetermined payments for health care services provided to patients
Policy holder a person who signs a contract with a health insurance company and who, thus, owns the health insurance policy
socialized medicine type of single-payer system in which the government owns and operates health care facilities and providers receive salaries
third party payer a health insurance company that provides coverage, such as BlueCross BlueSheild
accreditation voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law
capitation provider accepts pre-established payments for providing health care services to enrollees over a period of time (usually on year)
fee for services reimbursement methodology that increases payment if the health care service increase, if multiple units of service are provided, or if more expensive services (e.g. brand name vs generic prescription drugs)
gag clause prevents providers from discussing all treatment options with patients, whether or not the plan would provide reimbursement for services
gatekeeper primary care provider for essential health care services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists
EFT Electronic Funds Transfer
EHR Electronic Healthcare Records
EOB Explanation of Benefits
FECA Federal Employment Compensation Act
HCPCS Healthcare Common Procedural Coding System
HIPAA Health Insurance Portability Accountability Act
HMO Health Maintenance Organization
ICD International Classification of Disease
IPA Independent Practice Association
IPO Integrated Provider Organization
IPPS Inpatient Prospective Payment System
Created by: cheri le
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