CPB Chapter 2 Glossary, Questions and answers, 100% Accurate, Rated A+

CPB Chapter 2 Glossary, Questions and answers, 100% Accurate, Rated A+ Accountable Care Organizations (ACO) - -A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Capitation - -Fixed payment remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient. Carve-out - -A service not covered in a health insurance contract, usually reimbursed according to a different arrangement or rate formula than those services specified under the contract umbrella. Consumer Driven Health Plans (CDHP) - -Third tier insurance plans that give the members more control over their health budgets. Copay - -A specified dollar amount the policyholder must pay to a healthcare provider for each visit or medical service received. This is typically found on the insurance card. Credentialing - -A process that is used to evaluate the qualifications and practice history of a physician which includes a review of a physician's completed education, training, residency, and licenses. Customized Sub-Capitation (CSC) - -Managed care plan in which healthcare expenses are funded by insurance coverage; the individual selects one of each type of provider to create a customized insurance premium. DEERS (Defense Enrollment Eligibility Reporting System) - -A worldwide computerized database of all uniformed service members, their spouses and family members, and others who are eligible for TRICARE. Deductible - -An annual specified dollar amount the policyholder must pay before the insurance carrier begins paying for services. Employers' Liability Insurance - -Insurance that protects an employer from damages from a lawsuit resulting from an injury due to the employer's negligence. Exclusive Provider Organization (EPO) - -An organization that has entered into contracts with medical care providers or groups of medical care providers to provide healthcare services to members. Flexible Spending Account (FSA) - -A tax-advantaged healthcare account an individual contributes money into that is used to pay for certain out-of-pocket healthcare costs. Gatekeeper - -A physician, typically a primary care physician, like a family practitioner, internist, or pediatrician, who is responsible for determining a patient's primary services and coordinating care so that the patient receives the appropriate needed services. Group Health Plans - -Health plans that are purchased by employers for its employees. A portion of the group health plan premium may be paid by the employer. Group Practice Without Walls (GPWW) - -A medical practice formed to share economic risk, expenses, and marketing efforts. Health Maintenance Organization (HMO