Healthcare Laws
This federal law protects a patient’s sensitive health information
What is the Health Insurance Portability and Accountability Act or HIPAA
This document explains how an insurance company processed a claim
What is an Explanation of Benefits
One of these is a fixed amount you pay for a health care service before or after you meet your deductible, while the other is a percentage of the total cost you pay usually only after you’ve met your deductible
What is co-pay and coinsurance
These plans replace original Medicare coverage and often provide additional services not covered by original Medicare
What is Managed Medicare
This Act makes health insurance available to more people. The law provides consumers with subsidies (the “premium tax credit”) that lower costs for households with incomes between 100% and 400% of the federal poverty level
What is the Affordable Care Act (ACA)
Labs, signed notes, and procedure reports are released to patient portals as soon as they are available to prevent information blocking in support of this federal law
What is the 21st Century Cures Act
This is a requirement that a healthcare provider (such as your primary care physician or a hospital) gets approval from your insurance plan before prescribing you medication or doing a medical procedure
What is a Prior Auth
This is the amount you pay each month to keep your insurance policy active
What is an insurance premium
A form of employer insurance coverage that pays benefits to workers who have been injured or disabled due to a work-related accident, illness, or injury
What is Workers Compensation
A place where consumers in the United States can purchase private individual/family health insurance plans and receive income-based subsidies to make coverage and care more affordable
What is the Health Insurance Marketplace/Exchange
If a provider accepts payment for sending referrals or services to a specific location they are violating this
What is the Anti-Kickback Statute
If an out of network provider bills a patient for a service at a higher cost than their insurance would be willing to pay for that service in-network the patient will experience this through their insurance
What is balance billing
A payment program that reimburses/rewards providers based on the quality and cost of care they provide
What is Value Based Payment Arrangement (VBP)
A joint Federal and State program that provides health coverage to low-income individuals and families
What is Medicaid
The Affordable Care Act (ACA) is a law that prohibits this reason to deny, increase premiums, or impose waiting periods for health insurance coverage
What is the presence of pre-existing conditions
The No Surprises Act protects patients from this
What is receive unexpected bills for services received from a health care provider or facility that you did not know was out-of-network
A healthcare provider who is not a part of your insurance plan’s network would be considered this
What is an out-of-network provider
The amount of money you pay before your insurance company starts paying for covered expenses
What is a deductible
The biggest insurance payers in our community
What are Excellus, Aetna and Medicare/Medicaid
The Affordable Care Act (ACA) allows young adults to remain on their parents’ health insurance plan until this age
What is 26 years old
This act makes it illegal to submit claims for payment to Medicare or Medicaid that are known—or should be known—to be false
What is the False Claims Act
This type of insurance plan usually has higher monthly premiums, out-of-pocket costs, and deductibles but also a wider network of providers appealing for those who travel a lot and want the flexibility of seeing providers out of network
What is a PPO plan
A unit used to compare the value of different medical procedures and services and determines how much to reimburse healthcare providers
What is an RVU
Medicare coverage that covers inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care
What is Medicare Part A
These plan types are not subjected to certain ACA provisions such as preventive care coverage
What are grandfathered health insurance plans