Question

CHAPTER 11 KEY TERMS/ABBREVIATIONS

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

please define

Answer 1

Health maintaonence organization is considered to be the health insurance group that gives health services for a fixed annual fee. There main focus is to overall patient wellness andprevrntive healthcare. It covers emergency care of the patient.

Exclusive provider organisation - it is a health insurance plan which requires us to use doctors as well as hospitals within its own network. It is more like hpo. It cost less than hpo and ppo. In this plan primary care provider is not necessary.

Buffing the chart happens when the information is entered in record which was not stated by the patient not seen in the exam, not documented in the procedure or is simply not true.

Gatekeeper is either a physician or nurse who is first to see the patient and thus controls the patient history into the health care system.

COPAY - copayment. This is the amount paid to health care expenses. Mostly it is paid once you meet your deductible limit.

PCP - Primary care physician. This can be doctor, nurse, specialist, physician assistant or health care clinics that provides as well as coordinates your health care. When a person joins health care plan, then they might be asked to choose PCP who will be in charge of care.

POS - point of service plan. It's a type of managed care health insurance plan which provides various benefits which depends on whether the policy holder utilises in or out network health care providers. It combines the features of health maintainence organization and preferred provider organisation.