AAPC CPB - Chapter 2 Terminology Q& A 2024.

AAPC CPB - Chapter 2 Terminology Q& A 2024. Accountable Care Organization (ACO) -ANSWER 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 assigned population of patients Capitation -ANSWER Fixed payment remitted at a regular intervals to a medical provider by a managed care organization for an enrolled patient Carve-Out -ANSWER A service not covered in a health insurance contract, usually reimbursed according to a different arrangement of rate formula than those services specified under the contract umbrella Consumer Driven Health Plans (CDHP) -ANSWER Third tier insurance plans that give the members more control over their health budgets Copay -ANSWER A specified dollar amount that the policyholder must pay to a healthcare provider for each visit or medical service received. This is typically found on the insurance card Credentialing -ANSWER 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) -ANSWER 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) -ANSWER A worldwide computerized database of all uniformed service members, their spouses and family members, and others who are eligible for TRICARE Deductible -ANSWER An annual specified dollar amount the policyholder must pay before the insurance carrier begins paying for services Employers' Liability Insurance -ANSWER Insurance that protects an employer from damages from a lawsuit resulting from an injury due to the employer's negligence Exclusive Provider Organization (EPO) -ANSWER An organization that has entered into contracts with medical care providers or groups of medical care providers to provide healthcare services to members