#1
What is a co-payment in medical insurance?
A fixed amount paid by a patient for covered services
ExplanationFixed patient payment for covered services
#2
What does the term 'out-of-pocket maximum' refer to in health insurance?
The most a patient will have to pay for covered services in a plan year
ExplanationMaximum patient payment in a plan year
#3
What does 'fee-for-service' (FFS) mean in healthcare?
A payment model where services are unbundled and paid for separately
ExplanationPayment model for unbundled services
#4
What is 'Medicare'?
A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease
ExplanationFederal insurance for seniors, disabled, and ESRD patients
#5
What does 'Medicaid' cover?
Healthcare services for individuals and families with low income and resources
ExplanationHealthcare services for low-income individuals and families
#6
What is a 'deductible' in an insurance policy?
The amount paid out-of-pocket before an insurer pays any expenses
ExplanationOut-of-pocket amount before insurance coverage
#7
What does capitation mean in healthcare financing?
A system where providers are paid for each patient enrolled over a period of time
ExplanationProviders paid per patient over time
#8
What is DRG (Diagnosis-Related Group)?
A system to classify hospital cases into one of initially 467 groups
ExplanationClassification system for hospital cases
#9
What is 'balance billing' in the context of healthcare services?
Sending a bill to the patient for the remaining balance after insurance payment
ExplanationBilling patient for remaining balance after insurance
#10
What does 'prior authorization' in health insurance entail?
Approval from an insurance company before receiving certain healthcare services
ExplanationInsurance approval before certain services
#11
In medical billing, what is an 'explanation of benefits' (EOB)?
A statement from an insurance company explaining what treatments and services were paid for
ExplanationInsurance statement on paid treatments and services
#12
What does 'coinsurance' mean in health insurance terms?
A percentage of the cost that the insured pays after the deductible has been met
ExplanationPercentage of cost paid after deductible
#13
What is the significance of the Resource-Based Relative Value Scale (RBRVS) in healthcare?
It determines the prices for medical services based on the resources required to provide them.
ExplanationDetermines medical service prices based on resources
#14
What is the primary goal of 'value-based care'?
To improve patient outcomes by linking payments to the quality of care
ExplanationLinking payments to care quality to improve outcomes
#15
What is 'risk adjustment' in health insurance?
A financial adjustment applied to insurance premiums to reflect the health status of enrolled individuals
ExplanationPremium adjustment for enrolled individuals' health status
#16
What is 'stop-loss insurance' in the context of health care?
A type of reinsurance that provides protection for insurers against large claims
ExplanationInsurance protection against large claims for insurers