CCM WITH COMPLETE SOLUTIONS 100% 2023/2024
HMO
health maintenance organization
ACO
Accountable Care Organization
Viatical Settlements
ability to sell own insurance policy
CHAMPVA
Civilian Health and Medical Program of the Veterans Administrationtr
CHAMPVA for Life
provides...
CCM WITH COMPLETE SOLUTIONS 100% 2023/2024
HMO
health maintenance organization
ACO
Accountable Care Organization
Viatical Settlements
ability to sell own insurance policy
CHAMPVA
Civilian Health and Medical Program of the Veterans Administrationtr
CHAMPVA for Life
provides healthcare benefits to families of permanently disabled veterans, or killed in line of duty, not
eligible for tricare. Covers 65 or older, is a Medicare supplement.
TRICARE
is a U.S. government health insurance plan for active military personnel, national guard, reserves,
retirees, their families and some former spouse's.
TRICARE for Life
primarily a supplemental insurance with those with Medicare A & B coverage, &eligible for TRICARE in
US. Is the primary insurance overseas.
advance directives
A signed document indicating that the person's wishes regarding care during dying.
ASO
administrative services only, and insurance company or TPA that provides administrative services for
an employer group.
Adverse Events
any untoward occurrences not of natural consequences.
Advocacy
support; active pleading on behalf of someone or something
Alternate level of care
level of care used safely in place of current level, determined by acuity.
Assessments
The process of collecting in-depth information about a persons situation and function to identity
needs.
,assistive device
tool, software, or hardware to assist in performing daily activities
Assistive technology
equipment or products used by individuals with disabilities to improve functioning in activities
Autonomy
person's right to self determination and independence
Beneficence
Doing good or causing good to be done; kindly action
Beneficiary
a person who derives advantage from something, especially a trust, will, or life insurance policy.
Benefit package
the sum of services a health plan, government agency, or employer contracts to provide.
Benefits
the amount payable by the insurance company to a claimant or beneficiary under claimant s
coverage.
Brain injury
Any brain damage that impairs normal functioning of the brain, either temporarily or permanently
Burden of proof
the obligation facing a persuasive speaker to prove that a change from current policy is necessary
Capitation
fixed amount of money per member-per-month paid to care provider for covered services.
CARF
commission on accreditation of rehabilitation facilities, private, non profit organization that establishs
standards of quality services for people with disabilities.
Carve outs
services that are excluded from a provider contract, provider not responsible for services carved out
of contract
Caseload
total number of patients followed by a case manager at any point in time.
, case management
collaborative process that assesses, plans, implements, coordinates, monitors &evaluates options and
services to meet needs of individuals.
Case Management System
a computer program that helps a counselor organize information used to serve a specific client
Case mix index (CMI)
sum of DRG-relative weights of all patients seen in years time divided by patients hospitalized
Case rate
rate of reimbursement that packages pricing for a certain category of services.
Catastrophic case
case with complexities, multiple providers, and services that will be costly to patient and providers
Claims
request for payment or reparation for a loss covered by insurance contract.
Clinical pathways
a timeline of patient care activities and expected outcomes of care.
Coinsurance
a provision under which both the insured and the insurer share the covered losses, cost-sharing
Competence
the ability to do something successfully or efficiently, mental capacity
Concurrent review
method of reviewing patient care and services during a hospital stay to validate care necessity
Comorbidity
the co-occurrence of two or more disorders in a single individual
Continuous Quality Improvement
CQI, process of ongoing review to improve quality of healthcare services
Coordination of benefits (COB)
process to prevent duplication of payments when subscriber has coverage from multiple sources
Copayment
a fixed fee paid by the patient at the time of service, example office visit or prescription
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