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CBCS: Module 2 Vocab
| Term | Definition |
|---|---|
| Capitation | An agreement with a provider to receive a pre-established payment for health care services to enrollees over a period of time |
| Coinsurance | An agreement with a provider to receive a pre-established payment for health care services to enrollees over a period of time |
| Copayment (copay) | Flat, fixed amount that a patient pays for specific services (ex. office or emergency department encounters) |
| Covered Benefits | Services outlined in the policy that are payable by the health plan |
| Deductible | Annual amount the patient must pay before the insurance will begin to pay for covered benefits |
| Guarantor | The individual who is responsible for paying any patient responsibility after the insurance has processed a claim |
| Health Maintenance Organization | A group of contracted providers that agree to the payment contract for its members |
| In-Network (INN) | A provider who has signed an agreement with the insurance plan |
| Noncovered Services | Services that are not payable by the health plan |
| Out-of-Network (ONN) | A provider who does not have a signed agreement with an insurance plan |
| Policyholder | The individual who signs a contract with a health insurance company |
| Preferred Provider Organization (PPO) | A type of managed care organization where providers join network and are considered preferred when a patient seeks treatment |
| Premium | The amount a patient pays each month to receive benefits |
| HMO | Health Maintenance Organization |
| PPO | Preferred Provider Organization |
| CMS | Centers for Medicare/Medicaid Services |
| COB | Coordination of Benefits |
| CPT | Current Procedural Technologies |
| WC | Workers Compensation |
| ABN | Assignment of Benefits |
| HCPCS | Health Care Procedural Coding Services |
| DME | Durable Medical Equipment |
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