Introduction To Health Insurance

Front 1

Ambulatory Payment Classifications (APCs)

Back 1

The United States government's method of paying for facility outpatient services for the Medicare (United States) program.

Front 2

American Recovery and Reinvestment Act of 2009 (ARRA)

Back 2

The authorization and expansion of the EHR and the annual incentives for maintaining the implication of the program

Front 3

Balanced Budget Act of 1997 (BBA)

Back 3

Addresses health care fraud and abuse issues (also goes along with SCHIP)

Front 4

CHAMPUS Reform Initiative (CRI)

Back 4

Designed as a benefit for dependents of personnel serving in the armed forced as well as uniformed branches of the Public Health Service and the National Oceanic and Atmospheric Administration (now called TRICARE)

Front 5

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

Back 5

Provides healthcare benefits for dependents of veterans rated as 100 percent 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

Front 6

Clinical Laboratory Improvement Act (CLIA)

Back 6

Established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was preformed

Front 7

CMS-1500

Back 7

Used to submit Medicare claims

Front 8

Coinsurance

Back 8

Coinsurance is a health care cost sharing between you and your insurance company. The cost sharing ranges from 80/20 to even 50/50. For example, if your coinsurance is 80/20, that means that your insurer covers 80% of annual medical expenses and you pay the remaining 20%

Front 9

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Back 9

Allows employees to continue health care coverage beyond the benefit termination date

Front 10

Consumer-driven Health Plans (CDHPs)

Back 10

Organized into three categories:

1. Employer-paid high-deductible

2. Defined contribution

3. After-tax savings account

Front 11

Continuity of Care

Back 11

Involves documenting patient care services so that others who treat the patient have a source of information to assist with additional care and treatment

Front 12

Copayment (copay)

Back 12

A fee you pay for doctor's visit; may also vary depending on whether you seek a medical help in or out-of-network as well as on doctor’s specialty. It usually ranges between $10 and $40.

Front 13

Deductible

Back 13

The amount of money you pay for eligible medical expenses in a calendar year.

Front 14

Diagnosis-related Group (DRG)

Back 14

A statistical system of classifying any inpatient stay into groups for the purposes of payment

Front 15

Electronic Health Record (EHR)

Back 15

A more global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient

Front 16

Electronic Medical Record (EMR)

Back 16

A more narrow focus because it is the patient's created for a single medical practice

Front 17

Employee Retirement Income Security Act of 1974 (ERISA)

Back 17

Mandated reporting and disclosure requirements group life and health plans (including managed care plans), permitted large employers to self-insure employee health care benefits

Front 18

Evaluation and Management (E/M)

Back 18

The documentation for this services is based on three “key” components:

1. History
2. Physical Exam
3. Medical Decision-Making

Front 19

Federal Employee's Compensation Act (FECA)

Back 19

Provides civilian employees of the federal government with medical care, survivors' benefits, and compensation for lost wages

Front 20

Federal Employer's Liability Act (FELA)

Back 20

Protects and compensates railroad workers who are injured on the job; signed by President Theodore Roosevelt in 1916

Front 21

Fee Schedule

Back 21

A list of the plan's maximum payment amounts for specific services or supplies.

Front 22

Financial Services Modernization Act (FSMA)

Back 22

Prohibits sharing of medical information among health insurers and other financial institutions for use in making credit decisions

Front 23

Group Health Insurance

Back 23

Health insurance coverage subsidized by employers and other organizations

Front 24

Health Care

Back 24

Includes preventative services, identification of disease, and provision of care and treatment to persons who are sick, injured, or concerns

Front 25

Health Care and Education Reconciliation

(2010)

Back 25

Amended the PPACA to implement health care reform initiatives, such as increasing tax credits to but health care insurance

Front 26

Health Information Technology for Economic and Clinical Health Act (HITECH Act)

Back 26

Amended the Public Health Service Act to establish an Office of National Coordinator for Health Information Technology (ONC) within HHA to improve health care quality, safety, and efficiency

Front 27

Health Insurance

Back 27

A program that protects at least one person, available who need medical back-up

Front 28

Health Insurance Exchange

Back 28

Health Insurance Market

A place to buy health insurance

Front 29

Health Insurance Market

Back 29

Health insurance exchange

Front 30

Health Insurance Portability and Accountability Act of 1996 (HIPPA)

Back 30

Mandates regulations that govern privacy, security, and electronic transactions standards for health care information

Front 31

Hill-Burton Act (1946)

Back 31

Provided federal grants for modernizing hospitals that had to become obsolete because of a lack of capital investment during the Great Depression

Front 32

Home Health Prospective Payment System (HH PPS)

(1999)

Back 32

Reimburses home health agencies at a predetermined rate for health care services to patients implemented in 2000

Front 33

Individual Health Insurance

Back 33

Private policy purchased by individuals or families who do not have access to group health insurance coverage

Front 34

International Classification of Disease (ICD)

(1948)

Back 34

Developed by the World Health Organization (WHO) and is a classification system used to collect data for statistical purpose

Front 35

Gramm-Leach-Bliley Act

Back 35

Financial Services Modernization Act (1999)