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WEEK 3 MOD 4010
TERMINOLOGY
| Question | Answer |
|---|---|
| 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
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