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4010 week3
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| Question | Answer |
|---|---|
| CO-PAY | COPAYMENT |
| EPO | EXCLUSIVE PROVIDER ORGANIZATION |
| FMC | FOUNDATION FOR MEDICAL CARE |
| HMO | HEALTH MAINTENACE ORGANIZATION |
| IPA | INDEPENDENT OR INDIVIDUAL PRACTICE ASSOCIATION |
| MCO | MANAGED CARE ORGANIZATION |
| PCP | PRIMARY CARE PHYSICIAN |
| POS | POINT OF SERVICE |
| PPG | PHYSICIAN PROVIDER GROUP |
| UR | UTILIZATION REVIEW |
| PHP | PREPAID HEALTH PLAN |
| BUFFING | A PHTSICIAN JUSTIFYING THE TRANSFERENCE OF SICK, HIGH-COST PATIENTS TO OTHER PHYSICIANS IN A MANAGED CARE PLAN |
| CAPITATION | A SYSTEM OF PAYMENT USED BY MANAGED CARE PLANS IN WHICH PHYSICIANS AND HOSPITALS ARE PAID A FIXED PER CAPITA AMOUNT FOR EACH PATIRNT ENROLLED OVER A STATED PERIOD OF TIME |
| CARVE OUTS | MEDICAL SERVICES NOT INCLUDED WITHIN THE CAPITATION RATES AS BENEFITS OF A MANAGED CARE CONTRACT AND MAY BE CONTRACTED SEPARATELY |
| CHURNING | WHEN PHYSICIANS SEE A HIGH VOLUME OF PATIENTS MORE THAN MEDICAL NECESSARY TO INCEASE REVENUE |
| COPAYMENT | A PATIENTS PAYMENT OF A PORTION OF THE COST AT THE TIME OF SERVICE IS RENDERED |
| DEDUCTIBLE | A SPECIFIC DOLLAR AMOUNT THAT MUST BE PAID BY THE INSURED BEFORE A MEDICAL INSURANCE PALN OR GONVERNMENT PROGRAM BEGINS CONVERTING HEALTH CARE COST |
| DIRECT REFERRAL | AUTHORIZATION REQUEST FORM IS COMPLETED AND SIGNED BY THE PHYSICIAN AND HANDED TO PATIENT TO BE DONE DIRECTLY |
| GATEKEEPER | IN THE MANAGED CARE SYSTEM THIS IS THE PHYSICIAN WHO CONTROLS PATIENTS ACCESS TO SPECIALISTS AND DIAGNOSTIC SERVICES |
| PARTICIPATING PHYSICIAN | A PHYSICIANWHO CONTRACTS WITH AN HMO OR OTHER INSURANCE COMPANY TO PROVIDE SERVICES WHO HAVE AGREED TO ACCEPT A PLAN PAYMENT |
| TERTIARY | SERVICES REQUSTED BY A SOECIALIST FROM ANOTHER SPECIALIST |
| V CODES | HEALTH CARE ENCOUNTERS THAT OCCUR FOR REASONS OTHER THAN ILLNESS OR INJURY OR SPECIAL CIRCUMSTANCES OR PROBLEMS |
| E CODES | CODING USED TO DESCRIBE ENVIRONMENT EVENTS, CIRCUMSTANCES, AND CONDITIONS AS THE EXTERNAL CAUSES INJURY, POISONING, AND OTHER ADVERSE EFFECTS |
| ACCIDENTAL | UNEXPECTED HAPPENING CAUSING INJURY TRACEABLETO A DEFINITE TIME AN PLACE |
| BENGIN | DOES NOT HAVE THE PROPERTIES OF INVASION AND METASTASIS |
| MALIGNANT | HAS THE PROPETY OF INVASION AND METASTASIS |
| METASTSIS | SPEARD OF DISEASE-PRODUCING AGENCY (AS CANCER OR BACTERIA) FROM THE INITIAL OR PRIMARY SITE IF DISEASE TO ANOTHER PART OF THE BODY |
| NEOPLASM | ANY NEW OR ABNORMAL GROWTH OF TISSUE SERVING NO PHYSIOLOGICAL FUNCTION |
| POISIONING | CONDITION RESULTING FROM AN OVERDOSE OF DRUGS OR CHEMICAL SUBSTANCES OF FROM THE WRONG DRUG OR AGENT GIVEN OR TAKEN IN ERROR |
| PRIMARY | INITIAL OR IDENTIFICATION OF THE CONDITION OR CHEIF COMPLAINT |
| THERAPEUTIC USE | CORRECT SUBSTANCE ADMINISTERED PROPERLY AND AS PRESCRIBED |
| UNCERTIAN BEHAVIOR | BEHAVIOR OF THE NEOPLASM IS UNKNOWN AND CANNOT BE ASCERTIAN UNTIL A BIOPSY OR EXCISION IS PREFORMED |
| UNSPECIFIED BEHAVIOR | DIAGNOSTIC INFORMATION HAS NOT SPECIFIED THE NATURE OF BEHAVIOR THAT MAY BE KNOWN |
Created by:
markitaboyles
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