Alphabet Soup
MVA
What is a Motor Vehicle Accident?
An admission necessitated by an accident or medical emergency processed through the Emergency Department.
What is an Emergency Admission?
A health insurance plan or another entity that processes and pays healthcare bills.
Who is the Third Party Payor - Payor - Carrier - Insurer?
This a permission from the health insurance company required by managed care plans for certain outpatient services and/or surgeries prior to receiving care (except in an emergency). It is not a promise from the health insurance or plan to cover the cost.
What is a Preauthorization?
Sometimes called a prior authorization, prior approval, or precertification.
MSPQ
What is the Medicare Secondary Payer Questionnaire?
WC
What is Workers' Compensation?
An admission usually scheduled in advance from a doctor's office, clinic, or emergency room. The patients will usually have a room/bed reserved.
What is a Direct Admission?
The insured may elect to have other family members covered under the healthcare plan's family option. These terms are interchangeable and represent any person covered by the healthcare insurance plan.
Who is the Beneficiary - Enrollee - Member?
A written or electronic order from a primary care doctor to see a specialist or get specific medical services. (Used in a managed care plan)
What is a Referral?
HIPAA
What is the Health Insurance Portability and Accountability Act?
- Passed in 1996, the purpose of the law is to protect the privacy of a patient's personal and health information.
EMTALA
What is Emergency Medical Treatment and Labor Act (EMTALA)?
- This is a federal law requiring anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Also known as the anti-dumping law.
An admission always made or scheduled in advanced. It may be urgent or elective.
What is a Scheduled Admission?
- A direct admission can be a scheduled admission but a scheduled admission can not be a direct admission.
The individual who initiates healthcare coverage through the employer, private health plan, or other payor.
Who is the Insured - Subscriber - Policyholder - Sponsor?
The amount of cash paid to the provider by the health insurance plan, another payor, and patient for healthcare services.
What is Reimbursement?
PHI
What is Protected Health Information?
- Refers to individually identifiable health information transmitted or maintained in any medium: written, oral or electronic
MCR
What is Medicare?
A request by you or a healthcare system for payment by the insurance company for medical expenses covered under the insurance policy.
What is a Claim?
- The provider of a medical service will file a claim for you.
Part A
Part B
Part C or Medicare Advantage
Part D
What are Medicare Terms/Plans?
A person who relies on someone else for support, such as a child or elderly parent.
Who is a Dependent?
- A minor who is a dependent cannot be his/her own Guarantor. The Guarantor for a dependent minor will always be an adult.
501(r)
What are federal regulations regulating charity provided by a not for profit organization
MCD
What is Medicaid?
A document the patient must sign stating if Medicare denies payment for services rendered, the patient is then financially responsible for the cost(s).
What is an Advanced Beneficiary Notice?
The person who is responsible for payment of the bill.
Who is the Guarantor?
Documents indicating a patient's wishes in the event they become incapacitated and unable to make decisions regarding their own medical care.
What are Advanced Directives?
IHS
What is Indian Health Services?
- Works with tribes to provide health services to American Indians and Alaska Natives.