1. Patients
2. Providers
3. Payors
4. Suppliers
5. Researchers
6. Business Associates
Patient: Patient is also called beneficiary: person who has a medical condition (illness or diseases) and gets in contact with the medical provider for healthcare services.
Medicaid: A state administered federal and state funded insurance plan for low-income people who have limited or no insurance.
Medicare: Health insurance program for people age 65 and older. Medicare covers some people under age 65 who have disabilities or end-stage renal disease (ESRD).
Medicare + Choice: Medicare HMO insurance plan that pays for preventive and other healthcare from designated doctors and hospitals.
Medicare Part A: Usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
Medicare Part B: Helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
Medigap: Medicare Supplement Insurance that pays for some services not covered by Medicare A or B, including deductible and coinsurance amounts.
Non-Covered Charges: Charges for medical services denied or excluded by your insurance. You may be billed for these charges.
Outpatient (OP): Patient who does not need to stay overnight in a hospital. Outpatient services include lab tests, x-rays, and some surgeries. A service you receive in one day at a hospital or clinic without staying overnight.
Point-of-Service Plan (POS): An insurance plan that allows you to choose doctors and hospitals without having to first get a referral from your primary care doctor.
Pre-Existing Condition: A health condition or medical problem that you already have before you sign up to receive insurance. Some health insurers may not pay for health conditions you already have.
Primary Insurance Company: The insurance company responsible for paying your claim first. If you have another insurance company, it is referred to as the Secondary Insurance Company.
Procedure Code (CPT Code): A code given to medical and surgical procedures and treatments
Secondary Insurance: Extra insurance that may pay some charges not paid by your primary insurance company. Whether payment is made depends on your insurance benefits, your coverage, and your benefit coordination.
Skilled Nursing Facility: An inpatient facility in which patients who do not need acute care are given nursing care or other therapy. The most common SNF facility is a nursing home. These facilities are usually run by nurses and would just have a visiting doctor on call.
2. Providers
3. Payors
4. Suppliers
5. Researchers
6. Business Associates
Patient: Patient is also called beneficiary: person who has a medical condition (illness or diseases) and gets in contact with the medical provider for healthcare services.
Medicaid: A state administered federal and state funded insurance plan for low-income people who have limited or no insurance.
Medicare: Health insurance program for people age 65 and older. Medicare covers some people under age 65 who have disabilities or end-stage renal disease (ESRD).
Medicare + Choice: Medicare HMO insurance plan that pays for preventive and other healthcare from designated doctors and hospitals.
Medicare Part A: Usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
Medicare Part B: Helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
Medigap: Medicare Supplement Insurance that pays for some services not covered by Medicare A or B, including deductible and coinsurance amounts.
Non-Covered Charges: Charges for medical services denied or excluded by your insurance. You may be billed for these charges.
Outpatient (OP): Patient who does not need to stay overnight in a hospital. Outpatient services include lab tests, x-rays, and some surgeries. A service you receive in one day at a hospital or clinic without staying overnight.
Point-of-Service Plan (POS): An insurance plan that allows you to choose doctors and hospitals without having to first get a referral from your primary care doctor.
Pre-Existing Condition: A health condition or medical problem that you already have before you sign up to receive insurance. Some health insurers may not pay for health conditions you already have.
Primary Insurance Company: The insurance company responsible for paying your claim first. If you have another insurance company, it is referred to as the Secondary Insurance Company.
Procedure Code (CPT Code): A code given to medical and surgical procedures and treatments
Secondary Insurance: Extra insurance that may pay some charges not paid by your primary insurance company. Whether payment is made depends on your insurance benefits, your coverage, and your benefit coordination.
Skilled Nursing Facility: An inpatient facility in which patients who do not need acute care are given nursing care or other therapy. The most common SNF facility is a nursing home. These facilities are usually run by nurses and would just have a visiting doctor on call.
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