Insurance Flashcards
What are the 4 types of insurance in athletic training?
Primary
Secondary
Liability
Catastrophic
What are the 4 Types of “Managed care plans”?
HMO
PPO
POS
EPO
What is “HMO”?
Prepaid contact between insurance company and provider.
What is “PPO”?
INS negotiated reduced rates with providers and cost more for the patient.
What is “POS”?
Allows patient to seek care outside of HMO for higher copayment.
What is “EPO”?
Provider have contract with insurance company, employer, and other entity.
What does “HMO” stand for?
Health Maintenance Organization
What does “PPO” stand for?
Preferred Provider Organization
What does “POS” stand for?
Point of Service
What does “EPO” stand for?
Exclusive Provider Organization
What is “Medicare”?
INS for people 65 years old and up
What is “Medicaid”?
INS for low income
What are “CPT Codes”?
Documenting procedures in medical records.
What does “CPT” stand for?
Current Procedural Terminology
What is the “International Classification of Disease”?
International comparability of mortality statistics.
What is “UB-92”
Universal billing codes
What is “Advanced Beneficary Notice”?
Medicare document of provider
What is “Explantation of Benefits form”?
Wont be reimbursed with out it
What managed care program provides a set fee per member?
Capitation
A contractual obligation of one party to compensate the loss incurred to the other party due to the acts of the indemnitor or any other party.
Indemnity
Broadest sense is a natural person or other legal entity who receives money or other benefits from a benefactor.
Beneficary
What other name identifies a traditional indemnity insurance plan?
Fee-for-service
What health care organization defined services to enrolled patients for a specific sum of money during a specific time period.
HMO
Who is considered the “gatekeeper” of managed health care systems?
Primary Care physician
Who comprises the joint venture for Medicaid benefits?
Federal and state government
What are CPT and ICD codes?
Reimbursement codes
What management style did Mary Parker Follet propose?
Coorperation and democracy in the workplace
What team of health care workers are contracted to deliver health care to a specific population?
PPO
What reimbursement code do all health care workers use to describe the patients condition?
ICD 10 codes
What are CPT codes?
Billing codes
