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WEEK 3 MOD 4010

TERMINOLOGY

QuestionAnswer
BUFFING A PHYSICIANS JUSTIFYING THE TRANSFERENCE OF SICK, HIGH-COST PATIENTS TO OTHER PHYSICIANS IN A MANAGED CARE PLAN
CAPITATION A SYTEM OF PAYMENT USED BY MANAGED CARE PLANS IN WHICH PHYSICIANS AND HOSPITALS ARE PAID A FIXED PER CAPITA AMOUNT FOR EACH PATIENT ENROLLED OVER A STATED PERIOD OF TIME
CARVE-OUTS MEDICAL SERVICES NOT INCLUDED WITHIN THE CAPITATION RATE AS BENEFITS OF A MANAGED CARE CONTRACT AND MAY BE CONTRACTED FOR SEPERATELY
CHURNING WHEN PHYSICIANS SEE A HIGH VOLUME OF PATIENTS- MORE THAN MEDICALLY NECESSARY TO INCREASE REVENUE
COPAYMENT A PATIENTS PAYMENT OF A PORTION OF THE COST AT THE TIME THE SERVICE IS RENDERED
DEDUCTABLE A SPECIFIC DOLLAR AMOUNT THAT MUST BE PAID BY THE INSURED BEFORE A MEDICAL INSURANCE PLAN OR GOVERNMENT PROGRAM BEGINS COVERING HEALTH CARE COSTS
DIRECT REFERRAL THE AUTHORIZATION REQUEST FORM IS COMPLETED AND SIGNED BY THE PHYSICIAN AND HANDED TO THE PATIENT
Created by: reginacamarena