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QuestionAnswer
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