Question

please DEFINE

1. Health Maintenance Organization (HMO)

2. Exclusive Provider Organization (EPO)

3. BUFFING

4. GATEKEEPER

5. CHURNING

6. Point Of Service (POS)

7. TURFING

8. CAPITATION

9. UTILIZATION REVIEW

10. PRE-AUTHORIZATION

11. PRE- APPROVAL

12 .DEDUCTIBLE

12 .FEE FOR SERVICE

13 PARTICIPATING PHYSICIAN

ABBREVIATIONS:

1. COPAY

2. PCP

3. POS

4. PPO

5. UR

Answer 1

HMO definition: health maintenance organization is defined as a network or organization that provides health insurance coverage for a monthly or annual fee.

(It is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.)

Exclusive Provider Organization (EPO)

It is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Buffing

Buffing is defined as Spinning' a patient’s history to facilitate a turf transfer to another’s service.

Gatekeeper

Gatekeepers are people or policies that act as a go-between, controlling access from one point to another.

Churning

Churning is a popular term modified by the health and life insurance industry to encompass the act of convincing of a consumer to buy more life insurance, with the promise that it would be paid for with built-up values on old policies