Key Terms 1
A legal agreement in which physicians share staff and overhead expenses of operation but do not share in the legal responsibility or in profits of the business
What is Associate practice?
An amount of money that is paid by the insured before the insurance company pays for services. usually a fixed amount paid annually
What is deductible?
Fee-for-service plan that allow the patient to direct his or her healthcare. Typically require the patient to pay deductible and a percentage (cost-share) of the allowed charge. Allows both in-network and out of network coverage
What are Indemnity plans?
Federal programs that provides medical insurance coverage to members older than age 65 or those who are deemed permanent disabled.
What is Medicare?
A specific legal company structure that is designed for provision professional services for their clients, such as lawyers, physicians, or architects.
What is professional corporation (PC)
Acronym denoting Civilian Health and Medical Program of the Department of Veterans Affairs Coverage designed specifically for disabled veterans and their dependents. Also known as Veteran Health Administration.
What is CHAMPVA?
A person, such as the primary care physician or organization that is appointed by a managed care carrier to maintain and approve services to reduce costs and unnecessary spending.
What is a Gatekeeper
Obligations under law arising from civil actions or torts.
What is Liability?
Also called midlevel providers, providers who are educated and skilled to perform medical services and procedures similar to those of physicians.
What is a Non-Physician provider?
A single professional owned business in which an individual employs other professionals in the same field. In medical practice, a single physician owned practice that employs other physician to work for the practice.
What is Sole Proprietorship?
The percentage of payment that is agreed on by the insured as their portion of any claims; cost-sharing.
What is coinsurance
A medical practice with three or more physicians of the same or similar specialty, who share the same overhead and staff and practice medicine together
What is Group Practice?
A legally structured company in which the members of the company cannot be held personally liable for debts or actions of the company or another party in the company.
What is Limited Liability Company (LLC)
Insurance plan that combines some elements of HMO and PPO plans, and allows members to choose a primary care provider who will directly refer to in-network providers when needed.
What is Point of Service Plan (POS)?
In the medical field , an individual who has undergone further specific training in a certain discipline and practices medicine in that discipline, such as dermatology or endocrinology.
What is specialist?
A fixed amount determined by the health insurance policy that paid for services to offset premiums paid by the insured.
copay?
A type of manage care company that serves participating patients by offering services at a fixed rate within the group of a participating providers and facilities. A fixed fee schedule is negotiated with the provider as well.
What is Health Maintenance Organization?
Provides healthcare plans that balance healthcare delivery while controlling costs by limiting the providers who can be seen by the patient and discounting payments to those providers.
What is Managed Care Organization (MCO)?
A type of managed care organization that allow membes to see any in network proier without first obtaining a referral from the patient's primary care provide.
What is PPO?
Usually refers to an insurance company but can be any other person or organization that is responsible for the medical care coverage of patient.
What is Third party payer?