| A | B |
|---|
| Healthcare Plan | A system or insurance program that helps individuals pay for health-related services. |
| Universal Health Care | A system where eligible residents can access medically necessary physician and hospital services regardless of income. |
| Canada Health Act | Federal legislation that establishes principles provinces and territories must follow to receive federal health funding. |
| Public Administration | A Canada Health Act principle requiring plans to be operated on a non-profit basis by public authorities. |
| Comprehensiveness | A Canada Health Act principle requiring medically necessary services to be insured. |
| Universality | A Canada Health Act principle ensuring all eligible residents receive coverage. |
| Portability | A Canada Health Act principle allowing residents moving between provinces to maintain coverage during waiting periods. |
| Accessibility | A Canada Health Act principle requiring reasonable access to medically necessary services. |
| Provincial Health Plan | A publicly funded insurance plan administered by a province or territory for eligible residents. |
| OHIP | Ontario Health Insurance Plan. |
| MSI | Medical Services Insurance in Nova Scotia. |
| New Brunswick Medicare | New Brunswick's provincial health insurance plan. |
| Health Card | Proof of provincial or territorial coverage used to confirm eligibility and bill insured services. |
| Coverage Eligibility | A patient's qualification for insured services under a health plan or insurance policy. |
| Medically Necessary Service | A physician or hospital service required for patient care and generally covered by provincial health plans. |
| Insured Service | A service covered by a provincial health plan or another payer. |
| Non-Insured Service | A service not covered by a provincial health plan that may be billed to the patient or another payer. |
| Fee Schedule | A list of charges for services, often used for uninsured services or billing systems. |
| Sick Note | A document confirming illness or absence that may be a non-insured service. |
| Employment Form | A form requested for work-related purposes that may be a non-insured service. |
| Cosmetic Procedure | A procedure generally not considered medically necessary and often billed privately. |
| Driver's Medical Exam | A medical exam required for driving-related purposes that may be billed as a non-insured service. |
| Missed Appointment Fee | A fee charged when a patient misses an appointment according to clinic policy. |
| Interprovincial Reciprocal Payment Agreement | An agreement allowing eligible residents to receive medically necessary insured physician services outside their home province or territory, except Quebec, without paying out of pocket. |
| Out-of-Province Claim | A claim for insured services provided to a patient outside their home province or territory. |
| Quebec Exception | Quebec is generally excluded from the interprovincial reciprocal physician claim agreement. |
| Waiting Period | A period before new residents become eligible for provincial health coverage. |
| Private Health Insurance | Insurance that helps pay for services not fully covered by public health plans. |
| Extended Health Benefits | Additional benefits that may cover services such as drugs, dental care, vision care, physiotherapy, massage therapy, equipment, or counselling. |
| Deductible | The amount a patient may need to pay before insurance coverage begins. |
| Co-payment | The portion of a cost the patient pays at the time of service or after insurance is applied. |
| Premium | The amount paid to maintain insurance coverage; in physician billing, it may also mean an additional payment added when specific conditions are met. |
| Coordination of Benefits | The process used when a patient has more than one insurance plan and claims are shared between insurers to maximize coverage. |
| Direct Billing | A process where the healthcare provider submits claims directly to the insurance company on behalf of the patient. |
| Out-of-Pocket Expense | The amount the patient must pay personally after public or private coverage is applied. |
| Workers' Compensation | Specialized billing for workplace injuries or illnesses, usually processed through a provincial or territorial workers' compensation board. |
| Medical Billing | The process of charging for healthcare services, including recording services, submitting claims, collecting payments, and following up on balances or rejected claims. |
| Claim | A request for payment submitted to a provincial health plan, private insurer, or other payer. |
| Remittance | A payment notice from an insurer or payer showing what was paid, denied, reduced, or adjusted. |
| Billing Code | A standardized code used to identify healthcare services, procedures, or treatments for claims processing. |
| FFS | Fee-for-Service. |
| Alternative Payment Plan (APP) | A payment model introduced by some provinces to provide income stability, reduce administrative burden, and support team-based care. |
| Shadow Billing | Recording services that would have been billed under fee-for-service to track patient care, service volumes, and provider activity. |
| Capitation | Payment based on the number of rostered patients, regardless of how often each patient is seen. |
| Blended Model | A payment approach that combines more than one payment type, such as capitation and fee-for-service. |
| Time-Based Payment | Payment that reflects the amount of time required to provide a service. |
| Initiative Payment | Payment for participating in specific care initiatives, such as screenings or vaccinations. |
| Incentive | Additional payment for providers working in rural, remote, or underserved communities. |
| Bonus | Payment for meeting specific service or care targets. |
| Salary Model | A payment model where the provider receives a set amount for a defined period, regardless of the number of individual services performed. |
| Sessional Payment | Payment based on an agreed period of service, such as a shift or hourly rate. |
| Electronic Health Claims | Claims submitted or managed through systems such as EMRs, online insurance portals, billing software, or electronic claims processing. |
| Billing Confidentiality | Protecting patient health, financial, and coverage information during billing conversations and claims processing. |
| Ethical Billing | Billing practice based on honesty, accuracy, professional standards, patient rights, privacy, and confidentiality. |
| Fraudulent Billing | Misleading or false billing practices that can result in serious legal consequences. |
| Accurate Billing | Entering complete and correct billing information to support timely payment, reduce rejections, maintain compliance, and improve patient satisfaction. |
