Across
- 3. Care- Healthcare provided to people who cannot pay for it and who are not covered by any insurance. This includes both charity care which is not billed and the cost of services that were billed but never paid.
- 7. Party Administrator (TPA)- An organization that processes health plan claims but does not carry any insurance risk.
- 8. individual or institution who provides medical care, including a physician, hospital, skilled nursing facility, or intensive care facility.
- 11. services that members are entitled to receive based on their health plan. Cross/Blue Shield- Non-profit, tax-exempt insurance service plans that cover hospital care, physician care and related services. Blue Cross and Blue Shield are separate organizations that have different benefits, premiums and policies. These organizations are in all states, and The Blue Cross and Blue Shield Association of America is their national organization.
- 12. Care- Medical treatment rendered to people whose illnesses or medical problems are short-term or don't require long-term continuing care. Acute care facilities are hospitals that mainly treat people with short-term health problems.
- 13. Period- The amount of time a person must wait from the date he or she is accepted into a health plan (or from when he or she applies) until the insurance becomes effective and he or she can receive benefits.
- 15. Indemnity- The maximum amount of payment provided by an insurer for each covered service for a group of insured people.
- 17. amount paid to providers for services they provide to patients.
- 18. Integration- A healthcare system that includes the entire range of healthcare services from out-patient to hospital and long-term care.
- 19. Insurance- Health insurance that is provided by insurance companies such as commercial insurers and Blue Cross plans, self-funded plans sponsored by employers, HMOs or other managed care arrangements.
- 20. Assessment- Measurement of the quality of care
- 21. A percentage of providers' fees that managed care companies hold back from providers which is only given to them if the amount of care they provide (or that the entire plan provides) is under a budgeted amount for each quarter or the whole year.
Down
- 1. system- The process through which a primary care provider authorizes a patient to see a specialist to receive additional care.
- 2. plan-This benefit plan gives employees a set amount of funds that they can choose to spend on a different benefit options, such as health insurance or retirement savings
- 4. for services. Doctors, hospitals, labs and other providers send billed claims to health insurance plans, and what the plans pay are called paid claims.
- 5. Party Payer- An organization other than the patient or healthcare provider involved in the financing of personal health services.
- 6. A fixed prepayment, per patient covered, to a healthcare provider to deliver medical services to a particular group of patients. The payment is the same no matter how many services or what type of services each patient actually gets. Under capitation, the provider is financially responsible.
- 9. type of insurance arrangement where employers, usually large employers, pay for medical claims out of their own funds rather than contracting with an insurance company for coverage. This puts the employer at risk for its employees' medical expenses rather than an insurance company.
- 10. person who is eligible for or receiving benefits under an insurance policy or plan.
- 14. of care- How well health services result in desired health outcomes.
- 16. Integration- A healthcare system that includes the entire range of healthcare services from out-patient to hospital and long-term care.
- 19. Organization (PSO)- Healthcare providers (physicians and/or hospitals) who form an affiliation to act as insurer for an enrolled population