Three or more doctors joining together to deliver health care who agree to make joint use of equipment, supplies, and personnel, and divide income by a prearranged formula) began to form as these doctors finished their specialty training.
What are group practices
100
A fixed fee paid at each visit for each service rendered.
What is Copay
100
CHAMPUS is also known as what?
What is TRICARE
100
The process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on an insurance claim form.
What is Coding
100
the administrative agency within the federal Department of Health and Human Services (DHHS)
What is Health Care Financing Administration (HCFA)
200
The Current Procedural Terminology (CPT) was born when
What is 1966
200
The amount a patient pays on a monthly basis.
What is premium
200
reimbursement for income lost as a result of a temporary or permanent illness or injury.
What is Disability insurance
200
The mutual exchange of information between the provider and insurance company.
What is Electronic data interchange
200
data is sent in a standardized machine-readable format to an insurance company via disk, telephone, or cable
What is Electronic claims processing:
300
Most practices were made up of general practitioners, and the patients were responsible for payment to physicians and hospitals for services rendered in what years
What is 1900 – 1940
300
fee paid to the surgeon that covers a preoperative visit, the surgery, and normal postoperative care
What is Global surgical fee
300
a policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured.
What is Liability Insurance
300
a list of pre-established payment amounts for health care services provided to patients
What is a Fee schedule
300
the documentation submitted to an insurance plan requesting reimbursement of health care services provided
What is Health insurance claim
400
Because of government-enforced pay scales during WWII, many employers needed to find a way to retain good workers and attract new employees…thus the emergence of medical benefits. Employers began to offer employer-sponsored medical or health insurance policies as an incentive in what years
What is 1940 – Present
400
Payment method in which the health care provider receives one lump sum for all services rendered to the patient for a specific illness.
What is Episode of care
400
identification + treatment of disease
What is Medical care
400
A Medicare term for a situation in which the patient and the physician agree not to submit a claim for a service that would otherwise be covered and paid by Medicare. Physicians who do this “opt out” of the Medicare program for two years.
What is a Private contract
400
Any condition of the spine
What is Spondylosis
500
, patients covered by employer-sponsored medical or health care insurance began requesting that the physicians bill their health insurance before making payments on their accounts. They agreed to pay the balance due after the carrier determined the insurance portion of the claim.
What is the 1950's
500
the method used by HMOs and other managed care plans to pay the health care providers a fixed amount on a per capita (per person) basis. This fee is independent of the number of services rendered to the enrolled patients, meaning that no matter how many times the patient is seen (or not seen) the physician receives the same amount, usually called PMPM payment (per member per month).
What is Capitation
500
A contract between a policy holder and an insurance carrier or government program to reimburse the policy holder for all or a portion of the cost of medically necessary treatment rendered by health care professionals.
What is Health Insurance
500
Prior approval for treatment by specialists and post-treatment procedures.
What is Preauthorization
500
the mutual exchange of information between the provider and insurance company.