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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 |