abbreviations
UCR
usual customary reasonable
co-payment
amount of money paid by subscriber or beneficiary at each doctors visit
Medicaid
low income medically indigent month to month health cost assistance
HMO
Health Maintenance Organization
CMS-1500
Centers for Medicare & Medicaid Services insurance form
EOB vs ER
explanation of benefits
electronic remittance
premium
amount of money paid monthly or yearly for insurance plan
Tricare
health program for uniformed members and their families
capitation
payment per subscriber or per person
CPT vs ICD-10
current procedural terminology
international classification of diseases
PAR
participating provider
deductible
amount of money paid before insurance benefits begin to be paid out
ChampVA
Civilian Health & Medical Program of the Veterans Administration
families of veterans with disabilities or their survivors
PPO
preferred provider organization
referral vs consult
treatment by a specialist
one time visit for advice
COB
coordination of benefits
co-insurance
percentage of money owed by subscriber for health care costs per service
Medigap
insurance to cover the 20% that Medicare does not cover
point of service
POS-similar to HMO with out of network advantages for physician care
pre-certification
insurance plan does cover the service
PRO
peer review organization, evaluates effectiveness & efficiency of a health care facility
assignment of benefits
allows insurance to send payment of benefits directly to provider
MFS
Medicare Fee Schedule
fee for service
indemnity plan-
pre-authorization
insurance plan gives permission to have procedure done