EHR Flashcards
benefits
the amount of money a health plan pays for services covered in an insurance policy
capitation
a prepayment covering a provider’s services for a plan member for a specified period
coinsurance
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
copayment (copay)
an amount that a health plan requires a beneficiary to pay at the time of service for each health care encounter
covered services
medical procedures and treatments that are included as benefits under an insured’s health plan
deductible
an amount that an insured person must pay, usually on an annual basis, for health care services before a health plan’s payment begins
established patient (EP)
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
fee-for-service
health plan that repays the policyholder 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 plans, health insurance issuers, health maintenance organizations, Medicare Part A and B, Medicaid, TRICARE, and other government and nongovernment plans
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 appropriate, cost-effective health care services to its members
medical insurance
financial plan that covers the cost of hospital and medical care
new patient (NP)
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
noncovered services
medical procedures that are not included in a plan’s benefits
nonparticipating (nonPAR) provider
a provider who chooses not to join a particular government or other health plan
Office Hours break
a block of time when a physician is unavailable for appointments with patients
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 provider’s daily schedule
out-of-network
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
out-of-pocket
expenses the insured must pay before benefits begin
participating (PAR) provider
a provider who agrees to provide medical services to a payer’s policyholders according to the terms of the plan’s contract
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; the insured, subscriber, or guarantor
preauthorization
prior authorization from a payer for services to be provided; if preauthorization is not received, the charge is usually not covered
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 the office for an encounter
preventive medical services
care that is provided to keep patients healthy or to prevent illness, such as routine checkups and screening tests
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; 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
provider’s daily schedule
a listing of time slots for a particular day for a specific provider that corresponds to the date selected in the calendar
provider selection box
a selection box that determines which provider’s schedule is displayed in the provider’s 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
