Chapter 13

Question 1

Associate Practice

Answer 1

A legal agreement in which physicians share staff and overhead expenses of operation but do not share in the legal responsibility or in the profits of the business.

Question 2

CHAMPVA

Answer 2

Acronym denoting civilian health and medical programs of the dept of Veteran affairs. Coverage designed specifically for disabled veterans and their dependents. Also known as veterans Health administration

Question 3

Coinsurance

Answer 3

The percentage of payment that is agreed on by the insured as their portion of any claims; cost-sharing

Question 4

Copay

Answer 4

A fixed amount determined by the health insurance policy that’s paid for services to offset premiums paid by the insured

Question 5

Corporation

Answer 5

A company that is established legally and is managed by a board of directors.

Question 6

Deductible

Answer 6

An amount of money that is paid by the insured before the insurance pays for services. Usually a fixed amount paid annually

Question 7

Gatekeeper

Answer 7

A person such as the primary care physician or an organization that is appointed by a managed care carrier to maintain and approve services to reduce the costs of unnecessary spending

Question 8

Group Practice

Answer 8

A medical practice with 3 or more physicians of the same or similar specialty who share the same overhead and staff and practice medicine together.

Question 9

Health maintenance Organization(HMO)

Answer 9

A type of managed care company that serves participating patients by offering services at a fixed rate within the group of participating providers and facilities. A fixed fee schedule is negotiated with the providers as well.

Question 10

Incident to billing

Answer 10

A method of billing out patient services provided by non physician provider when working under the direct supervision of a physician

Question 11

Indemnity Plans

Answer 11

Fee for service plans that allow the patient to direct his or her healthcare. Typically require the patient to pay a deductible and a percentage (cost-share) of the allowed charge. Allows both in and out of network coverage

Question 12

Liability

Answer 12

Obligations under law arising from a civil action or tort

Question 13

Limited Liability Company (LLC)

Answer 13

A legally structured company in which the members of the company can not be held personally liable for the debts or actions of the company or another party in the company

Question 14

Managed Care Organization (MCO)

Answer 14

Provides healthcare plans that balance healthcare delivery while controlling costs by limiting the providers who can be seen by the patient and discounting payments to those providers.

Question 15

Medicaid

Answer 15

Federal program administered by each individual state that provides health care coverage for indigent and/or medically needy patients

Question 16

Medicare

Answer 16

Federal program that provides medical insurance coverage to members older than 65 and to those who are permanently disabled

Question 17

Non-physician Providers

Answer 17

Also called mid-level providers who are educated and skilled to perform medical services and procedures similar to those of the physicians

Question 18

Point-of-service Plans (POS)

Answer 18

Insurance plan that combines some elements of HMO and PPO plans and allows members to choose a primary care provider who will directly refer to in-network providers when needed.

Question 19

Primary Care Physician (PCP)

Answer 19

A designated provider whose over sees the care and manages the health care services for individuals.

Question 20

Preferred Provider Organization(PPO)

Answer 20

A type of managed care organization that allows members to see any in-network provider without first obtaining a referral from the patients primary care provider.

Question 21

Professional Corporation (PC)

Answer 21

A specific legal company that is designed for provision of professional services for their clients such as lawyers, physicians and architects

Question 22

Sole Proprietorship

Answer 22

A single professional owned business in which an individual employs other professionals in the same field. In medical practice, a single physician owned practice that employs other physicians to work for the practice

Question 23

Solo Practice

Answer 23

Single owner/operator of the company or business, in the medical field, this would represent a single physician practice

Question 24

Specialists

Answer 24

In the medical field, an individual who has undergone further specific training in a certain discipline and practices medicine in that discipline such as dermatology or endocrinology

Question 25

Third party payer

Answer 25

Usually refers to an insurance company but can be any other person or organization that is responsible for the medical care coverage of the patient

Question 26

TRICARE

Answer 26

Government medical program for active duty military and their dependents as well as coverage for military retirees (more than 20 years of expirence)