Chapter 13 Flashcards
Associate Practice
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.
CHAMPVA
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
Coinsurance
The percentage of payment that is agreed on by the insured as their portion of any claims; cost-sharing
Copay
A fixed amount determined by the health insurance policy that’s paid for services to offset premiums paid by the insured
Corporation
A company that is established legally and is managed by a board of directors.
Deductible
An amount of money that is paid by the insured before the insurance pays for services. Usually a fixed amount paid annually
Gatekeeper
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
Group Practice
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.
Health maintenance Organization(HMO)
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.
Incident to billing
A method of billing out patient services provided by non physician provider when working under the direct supervision of a physician
Indemnity Plans
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
Liability
Obligations under law arising from a civil action or tort
Limited Liability Company (LLC)
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
Managed Care Organization (MCO)
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.
Medicaid
Federal program administered by each individual state that provides health care coverage for indigent and/or medically needy patients
Medicare
Federal program that provides medical insurance coverage to members older than 65 and to those who are permanently disabled
Non-physician Providers
Also called mid-level providers who are educated and skilled to perform medical services and procedures similar to those of the physicians
Point-of-service Plans (POS)
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.
Primary Care Physician (PCP)
A designated provider whose over sees the care and manages the health care services for individuals.
Preferred Provider Organization(PPO)
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.
Professional Corporation (PC)
A specific legal company that is designed for provision of professional services for their clients such as lawyers, physicians and architects
Sole Proprietorship
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
Solo Practice
Single owner/operator of the company or business, in the medical field, this would represent a single physician practice
Specialists
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
Third party payer
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
TRICARE
Government medical program for active duty military and their dependents as well as coverage for military retirees (more than 20 years of expirence)
