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11 Cards in this Set
- Front
- Back
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PPO |
Participating provider organization (or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. When using out-of-network providers, PPO members are reimbursed at a reduced rate. |
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HMO |
Health maintenance organization. Most common type of MCO. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP. Most common MCO. |
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NCQA |
The National Committee for Quality Assurance is an independent non-profit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. |
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JCAHO |
Joint Commission on Accreditation of Healthcare Organizations is the oldest and largest accrediting body and is best known for accrediting hospitals and home health agencies. |
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MCO |
A managed care organization (MCO) is a health care provider or a group or organization of medical service providers who offers managed care health plans. Gov't doesn't require MCOs to be accredited, but NCQA is the most prominent accrediting body for MCOs. |
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PHP |
Pre-paid health plan |
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HI |
Hospital Insurance- Medicare Part A |
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SMI |
Supplemental Medical Insurance- Medicare Part B |
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Medicare |
First implemented in 1966 - Federal insurance provided to ppl older than 65 years old |
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Medigap |
Private insurance that pays most of the services not covered by Medicare A and B |
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EPO plans |
EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. You won't need to choose a primary care physician, and you don't need referrals to see a specialist.But you'll have a limited network of doctors and hospitals to choose from. EPO plans don't cover care outside your network unless it's an emergency. |
