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insurance terms

insurance terms and acronyms week 3

TermDefinition
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
Created by: lynn559