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Insurance Terms
| Term | Definition |
|---|---|
| Private Insurance | a plan provided through an employer or union; a plan purchased by an individual from an insurance company; or TRICARE or other military health coverage |
| Primary Insurance | health insurance that pays first on a claim for medical and hospital care |
| Premium | the amount of money an individual or business pays for an insurance policy |
| Secondary Insurance | health insurance that pays after primary insurance on a claim for medical or hospital care |
| Self Insured | setting aside your own money to pay for a possible loss instead of purchasing insurance and expecting an insurance company to reimburse you. |
| Self pay | to pay (something, such as a medical bill) with one's own money rather than money from another source |
| Government Plans | A program run by U.S. federal, state, or local governments in which people have some or all of their health care costs paid for by the government. |
| Co-pay | a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. |
| Deductibles | The amount you pay for covered health care services before your insurance plan starts to pay. |
| Explanation of benefits (EOB) | shows you the total charges for your visit. |
| Co-insurance | an insured individual's share of the costs of a covered expense |
| Remittance advice (RA) | contains information about your claim payments that Medicare Administrative Contractors (MACs) send, along with the payments, to providers, physicians, and suppliers. |
| Advance beneficiary notice (ABN) | The ABN lists the items or services that your doctor or health care provider expects Medicare will not pay for, along with an estimate of the costs for the items and services and the reasons why Medicare may not pay. |
| Medicare | federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions |
| Tricare | uniformed services health care program for active duty service members (ADSMs), active duty family members (ADFMs) |
| CHAMPVA | health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. |
| Medicaid | a joint federal and state program that helps cover medical costs for some people with limited income and resources. |
| Worker’s Compensation | protect people who become injured or disabled while working at their jobs |
| CHIP | covers children in families that earn too much money to qualify for Medicaid but cannot afford to buy private insurance |
| Group Policies | allows administrators to define security policies for users and for computers. |
| Individual Policies | a private health plan that covers an individual person as opposed to a group |
| HMO (Health Maintenance Organization | to coordinate health services and care provided to patients. |
| PPO (Preferred Provider Organization) | A type of medical plan in which coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians |
| Health Savings Account (HAS) | a type of personal savings account you can set up to pay certain health care costs. |
| Flexible Spending Account (FSA) | a special account you put money into that you use to pay for certain out-of-pocket health care costs |
| ICD-10-CM | a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings |
| Upcoding | “Upcoding” occurs when a healthcare provider submits codes to Medicare, Medicaid, or private insurers for more serious (and more expensive) diagnoses or procedures than the provider actually diagnosed or performed. |
| CMS-1500 form | The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers |
| Referrals | an act of referring someone or something for consultation, review, or further action. |
| Participating Provider | a healthcare provider that has agreed to contract with an insurer or managed care plan to provide eligible services to individuals covered by its plan |
| Account balance | the total amount of money held in a financial account at a specific time |
| Debit | the system of collecting life insurance premiums on a weekly or monthly basis involving an actual visit by the agent |
| Accounts receivable | the funds that customers owe your company for products or services that have been invoiced |
| Accounts payable | amounts due to vendors or suppliers for goods or services received that have not yet been paid for. |
| Credit | the ability of a customer to obtain goods or services before payment, based on the trust that payment will be made in the future. |
| Assets | your safety net against unforeseen damage to your physical assets. |
| Liabilities | Liability insurance provides protection against claims resulting from injuries and damage to people and/or property. |
| Electronic Medical Record | information about a patient's health history, such as diagnoses, medicines, tests, allergies, immunizations, and treatment plans. |
Created by:
K.Sams
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