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100
a national coordinating agency for physician sponsored health insurance plans
What is Association of Medical Care Plans
100
program that provides health benefits for dependents of veterans rated as 100% permanently and totally disabled as a result of service-connected conditions, veterans who died as a result of service-connected conditions, and veterans who died on duty with less than 30 days of active service
What is Civilian Health and Medical Programs of The Department of Veterans Affairs (CHAMPVA)
100
health care plan that encourages individuals to locate the best health care at the lowest possible price, with the goal of holding down costs; also called consumer-directed health plan
What is Consumer-Driven Health Plan
100
chronic kidney disorder that requires long-term hemodialysis or kidney transplantation because the patient's filtration system in the kidneys has been destroyed
What is End-Stage Renal Disease (ESRD)
100
health care coverage available through employers and other organizations (e.g., labor unions, rural and consumer health cooperatives); employers usually pay part, or all, of premium costs
What is Group Health Insurance
200
contract between an individual and an insurance company whereby individual pays a premium and, in exchange, the insurance company agrees to pay for specific car related financial losses during the term of the policy; typically includes protection (PIP) to reimburse health care expenses sustained as the result of injury from and automobile accident
What is Automobile Insurance Policy
200
established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed
What is Clinical Laboratory Improvement Act (CLIA)
200
provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each visit or medical service received
What is Copayment (copay)
200
services that describe patient encounters with health care professionals for evaluation and management of general health status
What is Evaluation and Management (E/M)
200
three or more health care providers who share equipment, supplies, and personnel, and divide income by a prearranged formula
What is Group Medical Practices
300
addresses health care fraud and abuse issues, and prices for Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) investigative and audit services on health care fraud cases
What is Balanced Budget Act of 1997 (BBA)
300
form used to submit Medicare claims; previously the HCFA-1500
What is CMS-1500/HCFA-1500
300
amount for which the patient is financially responsible before an insurance policy provides coverage
What is deductible
300
replaced the 1908 workers' compensation legislation; civilian employees of the federal government are provided medical care, survivors' benefits, and compensation for lost wages
What is Federal Employees' Compensation (FECA)
300
expands the definition of medical care to include preventive services
What is Health Care
400
period of time that usually covers 12 months and is divided into 4 consecutive quarters
What is Base Period
400
reimbursement for income lost as a result of a temporary or permanent illness or injury
What is disability insurance
400
list of predetermined payments for health care services provided to patients (e.g., a fee is assigned to each CPT code).
What is Fee Schedule
400
contract between a policyholder and a third-party payer or government program to reimburse the policyholder for all or a portion of the cost
What is Health Insurance
500
replaced the American Hospital Association (AHA) in 1972 as the approval agency for new and computer services but maintained separate corporate identities
What is Blue Cross Association (BCA)
500
allows employees to continue health care coverage beyond the benefit termination date
What is Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
500
mandated reporting and disclosure requirements for group life and health plans (including managed care plans), permitted large employers and dependents without regard to the enrollee's employment status (i.e., full-time, part-time, or retired)
What is Employee Retirement Income Security Act of 1974 (ERISA)
500
prohibits sharing of medical information among health insurers and other financial institutions for use in making credit decisions; also allows banks to merge with investment and insurance houses, which allows them to make a profit no matter what the status of the economy, because people usually house their money in one of the options; also called Gramm-Leach-Bliley Act
What is Financial Services Modernization Act/Gramm-Leach-Bliley Act
500
mandates regulation that govern privacy, security, and electronic transactions standards for health care information
What is Health Insurance Portability and Accountability Act of 1996 (HIPAA)