Medical/insurance Terms And Abbreviations

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Health maintenance Organization (HMO)

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Responsible for providing health care services to subscribes in a given geographical area for a fixed fee.

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Occupational Safety and Health Administration Act of 1970 (OSHA)

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legislation designed to protect all employees against injuries from occupational hazards in the workplace

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Major Medical Insurance

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Coverage for catastrophic or prolonged illnesses and or injury

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Primary care Provider/Primary Care physician (PCP)

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Responsible for supervision and coordination of health care services. Giving referrals when needed.

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Quality assurance

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A program that can access the quality of care that is provided in a health care setting

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Exclusive Provider Organization (EPO)

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A managed care plan that provides benefits to subscribers if they receive services from network providers.

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Preauthorization

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A review of medical necessity of test and procedures ordered

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Point of service (POS)

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Location of health care provider

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Out of Pocket Payment

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The amount paid before a high deductible is paid

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Preferred Provider (PPO)

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Is a network of physicians and hospitals that have joined together to contract with insurance companies, employers or other organizations

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Integrated Delivery System (IDS)

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An organization of affiliated providers sites that offer joint health care services to its subscribers

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

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A program that provides health benefits for dependents of veterans that are 100% disabled from the military service

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Clinical Laboratory Improvement Act (CLIA)

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Congress passed in 1988, to establish quality standards for all lab testing

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Copayment

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The amount an insured person is expected to pay at the time of each medical visit

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Deductible

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The amount the patient is responsible for before their insurance policy pays

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Authorization

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An Individuals formal or written permission to use or disclose his personal identifiable health information for purposes than treatment, payment or healthcare operations

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Clearinghouse

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An independent organization that receives insurance claims from the physicians office and performs software edits and redistributes the claim electronically to various third party payers

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Personal injury protection (PIP)

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• reimburses medical expenses for covered individuals regardless of fault for treatment due to an auto accident

• pays for funeral expenses lost earnings rehabilitation in replacement of service such as childcare if a parent is disabled

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Disability insurance

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reimbursement for income loss as a result of temporary or permanent illness or injury

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American medical association (AMA)

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A medical organization for medical professionals and medical students which promotes continued education and shared ideas

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Correct coding initiative (CCI)

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Developed to detect improper coded claims through the use of computer edits

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HIPAA

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Health Insurance Portability Accountability Act

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National health information infrastructure (NHII)

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Initiative to set forth to improve patient safety and quality of healthcare and to better inform individuals about their own health,to help them understand healthcare costs

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NPP

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Notice of Privacy Practices

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Advance beneficiary notice (ABN)

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An agreement signed by the patient prior to services or treatment given when physician believes Medicare will not cover the cost

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Medicare Part A

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Hospital Coverage

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Medicare B

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Physician services, outpatient

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Medicare part D

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Prescription drug coverage

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Medigap (MG)

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Covers out of pocket expenses that are not covered under Medicare

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Medicare secondary payer (MSP)

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Medicare is charged after primary insurance has paid

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OSHA

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Occupational safety and health administration

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Utilization management

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A method of controlling healthcare costs and quality of care by reviewing inappropriateness in a society of care

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Case management

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Involves development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner

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Electronic Medical record (EMR)

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Computer-based system for recording delivering in managing patient’s personal data

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Computer-based patient records (CPRs)

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Any information at doctor visits hospital visits or any medical facility

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Electronic health record (EHR)

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A complete chronological and comprehensive documentation of patient’s health history and status through their lifetime

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Personal health record (PHR)

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A computerized record about an individual patient health and health care

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Health insurance reform

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Provides continuous insurance coverage for workers and their insured dependent when they change or lose jobs

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Administrative simplification

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Focuses on the healthcare practice setting and is intended to reduce administrative costs and burdens

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Centers for Medicare and Medicaid services (CMS)

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Will enforce the insurance portability and transaction code set requirements of HIPAA

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Office of civil rights (OCR)

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Will enforce privacy

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Office of Inspector General (OIG)

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Safeguards the health and welfare of the beneficiaries of health and human services programs (HHS)

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Right to notice of privacy practices (NPP)

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Patients are entitled to receive and written notice of privacy practices of the provider at the first appointment the front desk is the ideal place to distribute the NPP

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CPR

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Computer-based patient records

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PHI

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Protected health information

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Anti kickback law

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Illegal for providers to accept bribes for any medical attention.

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The stark law

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Prohibits from a position to referring a Medicare patient to any otherNeeded help service in which he or she is related to

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Federal False Claims Act

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Makes it a crime for anybody to make a false record or false claim regarding any health program

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Truth in lending act

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Protects you against inaccurate and unfair credit billing

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Fair debt collection practices Act

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Makes it illegal for debt collectors to use abusive or unfair practices when they collect debts

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A/R Accounts receivables

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The amounts owed to a company by its customers