Money Talk
Alphabet Soup
Negotiations
Human Resources
Potpourri
100
  • Contribution from employer, employee, or consumer of health insurance
  • What is Premium?
100
  • A type of health insurance plan that usually limits coverage to a network of providers who have contracted a specific rate of payment with the insurance company

What is a Health Maintenance Organization (HMO) Plan?

100
  • Coverage from a provider who has opted not to negotiate a contracted rate of payment with a insurance company

What is out-of-network coverage?

100
  • A personal savings account of pre-tax dollars to pay for qualified medical expenses

What is a Health Savings Account (HSA)?

100
  • A fixed maximum number of visits per plan year

What is a visit limit?

200
  • The monetary amount a consumer/patient/client must pay in reimbursement for health care before the insurance company begins to contribute reimbursement

What is a deductible?

200
  • A type of health insurance plan that has coverage options at different payment levels for in-network care (contracted rate) and out-of-network care (higher rate to patient) for flexibility in choice of provider

What is a Preferred Provider Organization (PPO) Plan?

200
  • Coverage from a provider who has contracted a rate of payment to provide services to participants of a health insurance company

What is in-network coverage?

200
  • A type of savings account that employers allow employees to contribute a portion of their regular earnings to pay for health-related costs

What is a Flexible Savings Account (FSA)?

200

This insurance covers wages in addition to medical costs 

What is Worker's Compensation?

300
  • A percentage amount that is applied to the consumer/patient to supplement what the insurance company reimburses the provider

What is co-insurance?

300
  • A type of insurance plan where you pay less if you see a provider within the network provided by the insurance plan, requires a referral from a primary care provider

What is a Point of Service (POS) Plan?

300
  • A negotiated rate for reimbursement between a provider and an insurance company

What is a contracted rate?

300
  • Set times when a consumer/patient can choose which health insurance plan to remain in or change to

What are enrollment times?

300
  • A fixed dollar amount of reimbursement to a provider for healthcare services regardless of volume of services provided

What is capitated payment?

400
  • A dollar amount that is paid for reimbursement to the provider before the insurance company contributes reimbursement for services

What is a co-payment?

400
  • A traditional type of insurance plan that will either reimburse the provider directly after services are rendered or reimburse the consumer/patient after they have paid for services

What is a Fee-for-Service (FFS) Plan?

400
  • Uniform nomenclature for billing for medical services

What is a Current Procedural Terminology (CPT) Code?

400
  • A type of insurance that gives employees an option to continue their group health insurance plan for a period of time after certain circumstances including voluntary and non-voluntary job loss, reduction in hours worked, transition between jobs, and divorce or death

What is the Consolidated Omnibus Budget Reconciliation Act (COBRA)?

400

This is how a clinician can discuss options for continued care for a patient before a formal denial

What is a peer to peer review?

500
  • The maximum cost to the patient in a plan year

What is out-of-pocket maximum?

500
  • A health insurance plan option that carries a higher initial cost to the consumer/patient to receive healthcare services

What is a High Deductible Health Plan (HDHP)?

500
  • A negotiated flat rate for each physical therapy visit regardless of volume or time of service provided

What is per-visit-payment?

500

This allowed individuals who did not get credible health insurance through their employer (or spouses employer) to access health insurance through "marketplaces"

What is the Affordable Care Act?

500
  • A negotiated flat rate of payment for an episode of care regardless of volume of visits or services provided

What is per-episode-payment?

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