Insurance Terminology Flashcards
Advance Beneficiary Notice
A form provided to the patient when the doctor believes Medicaid will not cover services
Allowed amount
the maximum amount a third party payer will pay for a particular procedure or service
Copayment
Amount of money payed at the time of service
Coinsurance
Policyholder and insurance company share the cost of covered losses in a specific ratio
Deductible
a specified amount of money that the insured must pay before an insurance company will pay a claim.
Participating Provider (PAR)
providers who agree to write off the the difference between the amount charged by the provider and the approved flee established by insurer.
Medicare
covers patients 65 and older by hospitalization *Part A and Part B (routine visits)
Tricare
authorizes dependents of military to to recieve treatment from civilians at the expense of federal government
CHAMPVA
covers surviving spouses and children of veterans who died as a result of service related disability
Medicaid
provides insurance to medically poor population in return for preset scheduled payments and coordinated care in a system of providers
Managed Care
- umbrella term for systems like Medicaid
Patient Centered Medical Home
A partnership between a patient and their care team in which total health is the focus and not just a single condition. A health care team consists of a provider (physician, nurse practitioner, physician assistant), CMAA, CCMA, nurses, and pharmacist.
Fee for Service Model
- system where insurance carriers determine the allowed charge either by
- a fee schedule or
- through service benefits that define covered services but not necessarily the exact payments.
Value Based Plan
ocus on early prevention and are more holistic
Capitation
A managed care method of monthly payments to the provider based on the number of enrolled patients, regardless of how many encounters a patient may have during the month.
