Chapter 4 Flashcards
Benefits
the amount of money a health plan pays for services covered in an insurance policy
capitation
a prepayment covering providers services for a plan members a specified period
coinsurance
The portion of charged that an insured person must pay for health care services after payment of the deductible
copayment (copay)
an amount tat health plans requires beneficiary to pay at the time of services for each health care encounter
Covered services
medical procedures and treatments that are included as benefits under an insured’s heath plan
Deductible
an amount that an insured person must pay usually on an annual basis for health care services before an health plans payments begins
established patient (EP)
patient who has received professional services from a provider with in the past three years
fee-for-service
health plan that repays the policyholders for covered medical expenses
Health plan
An individual or group plan that either provides or pays for the cost of medical care: includes group health cares.
indemnity plan
type of medical insurance that reimburses a policyholder for medical services under the terms of its schedule of benefits
Managed care
system that combines the financing and delivery of appropriates, cost-effective health care services to its memebers
medical insurance
financial plans that covers the cost of hospital and medical care
new patient (NP)
a patient who has not received professional services from a provider within the past three years
non covered services
medical procedures that are not included in a plans benefits
nonparticipating (non PAR) provider
a provider who chooses not to join a particular government or other health plans
office hours calendar
an interactive calendar that is used to select or change dates in office hours
office hours patient information
the area of the office hours window that displays information about the patient who is selected in the providers daily schedule
out-of-network
provider that dose not have a participation agreement wit h a plan using an out-of-network provider is more expensive for the plans enrollees
out-of- pocket
expenses the insured must pay before benefits begin
participating (PAR) provider
provider who agrees to provide medical services to a payer’s policyholders according to the terms of the plans of contracts
patient portal
secure website that enables communication between patients and health care providers for tasks such as scheduling, completing registration forms and making payments
payer
Health plan or program
policyholder
person who buys an insurance plan that insured subscriber or guarantor
preexisting condition
illness or disorder of a beneficiary that existed before the effective date of insurance coverage
premium
Money the insured pays to a health plan for a health care policy; usually paid monthly
preregistration
the process of gathering basic contact, insurance, and reason for visit information before a new patient comes into office for an encounter
preventive medical services
care that is provided to keep patients healthy and to to prevent illness such as check ups and screening
provider
person or entity that supplies medical or health services and bills for or is paid for the services in the normal course of business
providers daily schedule
listing of time slots for a particular day for a specific provider that corresponds to the date selected in the calender
provider selection box
selections box that determine which provider schedules is displayed in the providers daily schedule
referral
transfer of patient care from one physician to another
referral number
authorization number given by a referring physician to the referred physician
schedule of benefits
list of the medical expenses that a health plan covers
preauthorization
prior authorization form a payer for services to be provided
