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HCA
| Term | Definition |
|---|---|
| the amount you pay out-of-pocket for healthcare services before your health insurance begins to pay. | deductible |
| is a fixed amount you pay for a specific service or prescription at the time of receiving care. | copayment |
| the percentage of costs you pay for a healthcare service after you've met your deductible. | coinsurance |
| the amount you pay for your health insurance coverage, usually on a monthly basis. | premium |
| Healthcare services that are not typically covered by insurance, such as cosmetic surgery or over-the-counter medications. | non covered services |
| Healthcare services received from providers who are not in the patient's insurance network. | out of network care |
| a process used by insurance companies to determine if a medical procedure is necessary before it is performed. | precertification |
| voluntary process where a healthcare provider or patient requests a written statement from an insurance company about the coverage and costs of a proposed medical treatment, procedure, or service before it is performed. | predetermination |
| To obtain mandatory approval from the insurer before performing a specific procedure or prescribing a certain medication. | prior authorization |
| Is the process of creating a personalized plan to manage a patient's transition from one healthcare setting to the next | discharge planning |
| Used to describe medical, surgical, and diagnostic procedures and services. | CPT Codes |
| Used to classify and code diagnoses, symptoms, and procedures. | ICD Codes |
| -Healthcare Common Procedure Coding System. -Used to describe medical procedures, equipment, and supplies. | HCPCS codes |
| CPT codes maintained by the American Medical Association (AMA). (HCPCS level) | level 1 |
| Alphanumeric codes for non-physician services and products.(HCPCS level) | level 2 |
| codes cover ambulance services, durable medical equipment, prosthetics, and supplies. (HCPCS level) | level 3 |
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