Thursday, January 9
Pended Claim
An insurance term for claims that are missing information necessary for the insurer to make a coverage decision.
Wednesday, January 8
Third Party Payer
A company or organization other than the patient or care provider that pays a portion of the costs for the individual's health care.
Tuesday, January 7
Health-Contingent Wellness Program
Programs designed to encourage healthy behavior by offering rewards to participants that meet certain standards for health.
Monday, January 6
Relative Value Unit (RVU)
Basis of payment for the Medicare physician fee schedule.
Friday, January 3
Medicare Part D
A program within Medicare to offer private prescription drug coverage plans to beneficiaries. Plan premiums are subsidized and the coverage is optional.
Thursday, January 2
Adverse Selection
Adverse selection occurs when healthy people opt out of purchasing insurance, and thus the premium prices rise, which then causes additional people to opt out. The end result is a very sick risk pool and very expensive insurance premiums.
Friday, December 20
Precertification
Preapproval from an insurance plan before an enrollee undergoes routine care.
Thursday, December 19
Limited Medical Plans
Insurance plans that provide partial coverage for part-time workers who often cannot afford full insurance - often referred to as 'mini med' plans.
Wednesday, December 18
All-payer System
A type of health care system in which everyone - government, insurance company, or individual - pays the same amount for the same services, also known as Multiple Payer Systems. It should be noted that this does not reflect current U.S. health care policy.
Tuesday, December 17
Patient Protection and Affordable Care Act (PPACA)
The 2010 health care reform law, also referred to as the Affordable Care Act, the ACA, and Obamacare.