Word of the day

Friday, January 24

Adjudication

Administrative process for reviewing insurance claims

Thursday, January 23

Portability of Coverage

Refers to individuals having the ability to maintain coverage as they move from one job to another without a waiting period. It could also include coverage for individuals who are not connected to an employer when they have a change in employment.

Wednesday, January 22

Employer Pay-or Play

Requires employers to extend and pay for health benefits for their employees. It could also mean the employer pays a certain dollar amount of the pay roll into a public fund. This fund would then continue as financing for coverage for those who do not have employment-based coverage.

Tuesday, January 21

Quality Assurance and Quality Improvement

A method through which health care providers monitor their services and seek to improve quality of care.

Friday, January 17

Maximum Reimbursable Charge

Dollar limit on health care services, typically only applies to out of network coverage.

Thursday, January 16

Risk Corridor

Provision designed to manage unpredictability in the insurance market. Plans with lower than anticipated costs are required to pay a portion of their savings into a fund designated to help plans with higher than anticipated costs.

Wednesday, January 15

Medicaid Health Homes

Health care facilities designed to offer comprehensive, on-going care for patients with multiple chronic health conditions.

Tuesday, January 14

Current Procedural Terminology (CPT)

A medical code set by the American Medical Association, which describes medical, surgical and diagnostic services. The set is to be communicated among physicians, coders, patients and other relevant parties.

Monday, January 13

Gag Clause

A provision in a contract in which a health care provider is restricted in speaking about an insurer or their financial arrangement.

Friday, January 10

Young Invincibles

A phrase used to describe relatively healthy young adults who often forgo health insurance because they don’t anticipate needing medical care.

Obamacare

Commonly used political shorthand for the Patient Protection and Affordable Care Act, the 2010 health care reform law signed by President Obama; also referred to…