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insurance terms
insurance terms and acronyms week 3
Term | Definition |
---|---|
continuity of care | the delivery of services provided to a person that proceeds without a lapse or interruption, with the intended purpose of maintaining a level of health and treatment. |
copayment | a specified amount the insured must pay toward the charge for professional services rendered at the time of service. |
deductible | an amount to be paid before insurance will pay. |
Fee schedule | a list of predetermined payment amounts for professional services provided to patients. |
Policy holder | a person or group in whose name an insurance policy is held |
Socialized medicine | medical and hospital care for all at a nominal cost by means of government regulation of health care and subsidies derived from taxation. |
third party payer | a fancy way of referring to your health plan or health insurer. When you see a doctor or go in for a medical procedure, you'll pay a share of the bill, maybe through a copayment. |
accreditation | a process in which an educational institution or program establishes credibility or legitimacy by complying with predetermined standards. |
capitation | the health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization regardless of whether services were provided. |
fee for service | payment for each service that is provided; individuals who choose to pay high premiums so that they have the flexibility to seek medical care from health care professionals of their choice. |
gag clause | A gag clause is often used as part of an employment contract as a way for an employer to protect special and/or proprietary corporate information, trade secrets, and confidential employee information. |
gatekeeper | one who regulates access to someone or something; in insurance, a primary care physician who coordinates the patient's referral to specialists and hospital admissions. |
EFT | electronic funds transfer |
EHR | electronic healthcare records |
EOB | Explanation of Benefits |
ERA | electronic remittance advice |
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 |