Term | Definition |
continuity of care | documenting patient care services so that others who treat the patient have a source of information on which to base additional care and treatment |
copayment | provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service recieved |
deductible | amount for which the patient is financially responsible before an insurance policy provides coverage |
Fee schedule | list of predetermined payments for health care services provided to patients |
Policy holder | a person who signs a contract with a health insurance company and who, thus, owns the health insurance policy |
socialized medicine | type of single-payer system in which the government owns and operates health care facilities and providers receive salaries |
third party payer | a health insurance company that provides coverage, such as BlueCross BlueSheild |
accreditation | voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law |
capitation | provider accepts pre-established payments for providing health care services to enrollees over a period of time (usually on year) |
fee for services | reimbursement methodology that increases payment if the health care service increase, if multiple units of service are provided, or if more expensive services (e.g. brand name vs generic prescription drugs) |
gag clause | prevents providers from discussing all treatment options with patients, whether or not the plan would provide reimbursement for services |
gatekeeper | primary care provider for essential health care services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists |
EFT | Electronic Funds Transfer |
EHR | Electronic Healthcare Records |
EOB | Explanation of Benefits |
FECA | Federal Employment Compensation Act |
HCPCS | Healthcare Common Procedural Coding System |
HIPAA | Health Insurance Portability Accountability Act |
HMO | Health Maintenance Organization |
ICD | International Classification of Disease |
IPA | Independent Practice Association |
IPO | Integrated Provider Organization |
IPPS | Inpatient Prospective Payment System |