| A | B |
|---|
| HMO | Referral required, closed network |
| PPO | In and out of network provider, open network |
| FFS | Traditional Plan |
| POS | Gatekeeper |
| HSA | a tax-advantaged medical savings account available to taxpayers |
| FSA | a type of account used to pay for medical expenses not paid for by insurance |
| CDHP | Low premium, hight ded, preventative care is covered at 100% |
| Medicare | Most Americans who are 65 or older are insured by |
| Commercial Payers | Most Americans under the age of 65 are insured by |
| MAC | Has own local coverage |
| Managed care | A plan that uses a network of healthcare providers and facilities; cost effective health care. |
| Medi- Medi | Medicare Primary - Medicaid Secondary |
| site of care for a medical benefit | Physician's Office and/or Hospital Outpatient |
| site of care for a pharmacy benefit | Home (self administered drugs) |
| Assignment of Benefits | arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility |
| Hybrid Benefit | A HCP (Healthcare Provider) must send a RX (Prescription) to Specialty Pharmacy |
| Coverage | circumstances under which products and services are eligible for payment ; formalized policy |
| Payment | the value set by the payer for specific services or supplies |
| Coding | payers rely on the me to process claims for products and services |
