EHR

Question 1

benefits

Answer 1

the amount of money a health plan pays for services covered in an insurance policy

Question 2

capitation

Answer 2

a prepayment covering a provider’s services for a plan member for a specified period

Question 3

coinsurance

Answer 3

the portion of charges that an insured person must pay for health care services after payment of the deductible amount; usually stated as a percentage

Question 4

copayment (copay)

Answer 4

an amount that a health plan requires a beneficiary to pay at the time of service for each health care encounter

Question 5

covered services

Answer 5

medical procedures and treatments that are included as benefits under an insured’s health plan

Question 6

deductible

Answer 6

an amount that an insured person must pay, usually on an annual basis, for health care services before a health plan’s payment begins

Question 7

established patient (EP)

Answer 7

patient who has received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years

Question 8

fee-for-service

Answer 8

health plan that repays the policyholder for covered medical expenses

Question 9

health plan

Answer 9

an individual or group plan that either provides or pays for the cost of medical care; includes group health plans, health insurance issuers, health maintenance organizations, Medicare Part A and B, Medicaid, TRICARE, and other government and nongovernment plans

Question 10

indemnity plan

Answer 10

type of medical insurance that reimburses a policyholder for medical services under the terms of its schedule of benefits

Question 11

managed care

Answer 11

system that combines the financing and delivery of appropriate, cost-effective health care services to its members

Question 12

medical insurance

Answer 12

financial plan that covers the cost of hospital and medical care

Question 13

new patient (NP)

Answer 13

a patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years

Question 14

noncovered services

Answer 14

medical procedures that are not included in a plan’s benefits

Question 15

nonparticipating (nonPAR) provider

Answer 15

a provider who chooses not to join a particular government or other health plan

Question 16

Office Hours break

Answer 16

a block of time when a physician is unavailable for appointments with patients

Question 17

Office Hours calendar

Answer 17

an interactive calendar that is used to select or change dates in Office Hours

Question 18

Office Hours patient information

Answer 18

the area of the Office Hours window that displays information about the patient who is selected in the provider’s daily schedule

Question 19

out-of-network

Answer 19

a provider that does not have a participation agreement with a plan; using an out-of-network provider is more expensive for the plan’s enrollees

Question 20

out-of-pocket

Answer 20

expenses the insured must pay before benefits begin

Question 21

participating (PAR) provider

Answer 21

a provider who agrees to provide medical services to a payer’s policyholders according to the terms of the plan’s contract

Question 22

patient portal

Answer 22

secure website that enables communication between patients and health care providers for tasks such as scheduling, completing registration forms, and making payments

Question 23

payer

Answer 23

health plan or program

Question 24

policyholder

Answer 24

person who buys an insurance plan; the insured, subscriber, or guarantor

Question 25

preauthorization

Answer 25

prior authorization from a payer for services to be provided; if preauthorization is not received, the charge is usually not covered

Question 26

preexisting condition

Answer 26

illness or disorder of a beneficiary that existed before the effective date of insurance coverage

Question 27

premium

Answer 27

money the insured pays to a health plan for a health care policy; usually paid monthly

Question 28

preregistration

Answer 28

the process of gathering basic contact, insurance, and reason for visit information before a new patient comes into the office for an encounter

Question 29

preventive medical services

Answer 29

care that is provided to keep patients healthy or to prevent illness, such as routine checkups and screening tests

Question 30

provider

Answer 30

person or entity that supplies medical or health services and bills for or is paid for the services in the normal course of business; may be a professional member of the health care team, such as a physician, or a facility, such as a hospital or skilled nursing home

Question 31

provider's daily schedule

Answer 31

a listing of time slots for a particular day for a specific provider that corresponds to the date selected in the calendar

Question 32

provider selection box

Answer 32

a selection box that determines which provider's schedule is displayed in the provider's daily schedule

Question 33

referral

Answer 33

transfer of patient care from one physician to another

Question 34

referral number

Answer 34

authorization number given by a referring physician to the referred physician

Question 35

schedule of benefits

Answer 35

list of the medical expenses that a health plan covers