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Insurance in the Medical Office 7th Edition Chapter 6
Terms in this set (31)
Participating physician's agreement to accept allowed charge as full payment.
Change to a patient's account.
Maximum charge a plan pays for a service or procedure.
Collecting the difference between a provider's usual fee and a payer's lower allowed charge.
Single predetermined payment for an entire episode of care.
Periodic prepayment to a provider for specified services to each plan member.
A prepayment covering provider's services for a plan member for a specified period.
Consumer-driven health plan (CDHP)
medical insurance that combines a high-deductible health plan with a medical savings plan.
Amount used to multiply a relative value unit to arrive at a charge.
payment schedule for services based on a reduced percentage of usual charges.
List of the usual fees a physician charges.
Practice's rules governing payment from patients.
Flexible savings account (FSA)
Consumer-driven health plan funding option that has employer and employee contributions.
health maintenance organization
managed health care system in which providers offer health care to members for fixed periodic payments.
health reimbursement account (HRA)
Consumer-driven health plan funding option where an employer sets aside an annual amount for health care costs.
health savings account (HSA)
Consumer-driven health plan funding option under which funds are set aside to pay for certain health care costs.
high-deductible health plan (HDHP)
Health plan that combines high-deductible insurance and a funding option to pay for patients' out-of-pocket expenses up to the deductible.
independent practice association (IPA)
HMO in which physicians are self-employed and provide services to members and nonmembers.
Utilization of certified EHR technology to improve quality, efficiency, and patient safety in the health care system.
medicare physician fee schedule (MPFS)
The RBRVS-based allowed fees.
Payment made during checkout based on an estimate.
per member per month (PMPM)
Periodic capitated prospective payment to a provider that covers only services listed on the schedule of benefits.
Point-of-service (POS) plan
Plan that permits patients to receive medical services from non-network providers.
preferred provider organization (PPO)
managed care organization where a network of providers supply discounted treatment for plan members.
primary care physician (PCP)
Physician in a health maintenance organization who directs all aspects of a patient's care.
resource-based relative value scale (RBRVS)
Relative value scale for establishing medicare charges.
real-time claims adjudication (RTCA)
Process used to generate the amount owed by a patient.
Patient with no insurance.
UCR (usual, customary, reasonable)
Setting fees by comparing usual fees, customary fees, and reasonable fees.
Report that lists the diagnoses, services provided, fees, and payments received and due after an encounter.
To deduct an amount from a patient's account.
THIS SET IS OFTEN IN FOLDERS WITH...
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