IN PARTNERSHIP WITH FREE MARKET MEDICAL ASSOCIATION
Free Market Glossary of Terms
Free Market Facts
Frequently Asked Questions
An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider. Under the ACA, physician non-compliance with EHR results in reduced payments.
Direct Primary Care (DPC) is an alternative payment & practice model for primary care services. DPC physicians offer services for a flat monthly rate instead of a traditional fee for service arrangement. DPC physicians do not file insurance claims or recieve compensation of any kind from traditional insurance companies.
The amount of expenses that must be paid out-of-pocket by the individual before an insurer or plan will pay any expenses. Typically, the deductible only applies to claims that happen outside of the physicians office unless it is a “Qualified High Deductible Health Plan.” For example, a patient with a deductible of $1,500 having an outpatient surgery will be responsible for the first $1,500 of charges for that surgery before the benefit plan makes any payment to the provider.
A fixed payment for a covered service, defined by a participant’s benefit plan, which is paid by a covered person each time a medical service is rendered. The co-payment is often a small portion of the actual cost of the medical service (e.g. $25 per office visit).
In concierge medicine, the patient pays an annual/quarterly/monthly fee or retainer. Typically, concierge physicians still file insurance claims or charge fee for service.
A shared dollar amount, typically a percentage, between the participant and the insurer or plan. Coinsurance may apply to any specific benefit, but is generally applied to a claim after the deductible has been met. For example, after the deductible has been met, the participant may be responsible for 20% of the remaining amount, while the insurer or plan pays 80%.
Provides individuals with the right to continue health coverage under an employer plan for a limited time after certain events, such as the loss of a job
Legislation that restricts opening, expanding or building new medical facilities. These laws require owners of medical facility-care projects to prove public need and get approval for their projects before embarking upon them. The Federal Trade Comission and the Justice Department have encouraged states to abandon the laws as bad for competition, but they still exist in most states.
Buyers of medical care, including employers and individual patients.
Refers to a provider billing a patient for the difference between the provider’s charge and the payment received from the plan.
A carrier acting as a Third Party Administrator of a self-funded Plan. Many health insurance carriers offer both fully-insured and third party administrative services, which are often called administrative services only (ASO) often performed under an administrative services contract (ASC). Health insurance carriers and their subsidiaries provide most of the administrative services for enrollment covered under TPA agreements for health benefits.
On March 23, 2010, President Obama signed the health reform bill into law which made significant changes to the way employers and employees purchased health benefits, along with significant changes to the healthcare delivery system. The goals of the ACA were to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government. Since it’s passage, the law has been challenged in court numerous times by states, private industry, and others for a number of it’s provisions.