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15 Cards in this Set
- Front
- Back
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fee for service
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a set price for a service given:ie. i will give you this if you do this for me.
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discounted fee for service
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a negotiated payment that is less than the providers normal rate
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prospective payment
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a payment based on statistical data rather than individual costs of services
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capitation
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where an md gets paid for each individual patient wether seen or not usually on a monthly basis for being their pcp
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assumption of risk
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where an insurance company attempts to cover the greatest number of people for the lowest possible costs.
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indemnity
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where thr patient pays up front then sends bills to insurance company for reimbursement.
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deductable
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the amount of expenses the patient is required to pay before the insurance reimburses.
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managed care
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where the insurance company contracts with md's to provide services to their subscribers with the ins. co. making the decisions as to what is appropriate care and what is not, not what the md decides
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health maintenance organization(hmo)
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where tha insurer is both the payer and the provider and requires the pt to use their network or pay the full costs
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preferred provider organization
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is a hybrid of indemnity and hmo where there are different levels of coverage based on the network the patient chooses
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self-insurance
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also known as a flexible benefit account and is a savings account type program where the pt or their employer putso much money aside for medical costs.
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demographic data
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is the patient name, address, place of employment, phone number e.t.c. needed for distinguishing them from another patient and future contact.
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socioeconomic data
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an individual's marital status, education level, and personal habits
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financial data
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the information needed to generate reimbursement for services given
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clinical data
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is comprised of all the data regarding a patient's health including diagnosis and procedures.
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