Define the “Key terms” found in this Chapter.

a. Allowable Costs.

b. APCs.

c. Capitation.

d. Case Rate.

e. Charge-based.

f. CMMS.

g. Community Rating.

h. Contact Capitation.

i. Conversion Factor.

j. Copayment.

k. Cost-based Reimbursement.
l. Cost Shifting.
m. Deductibles.
n. Experience Rating.
o. Diagnosis Related Groups (DRGs).
p. Discounts.
q. Fee-for-service.
r. Financial Requirements.
s. Flat Fee.
t. Gatekeeper.
u. Group Model HMO.
v. Health Care Financing Administration (HCFA).
w. Health Maintenance Organization (HMO).
x. Indemnity Insurance.
y. Managed Care.
z. Medicaid.
aa. Medical Savings Account.
bb. Medicare.
cc. Members.
dd. Participating Provider.
ee. Payor.
ff. Per Diem.
gg. Premium.
hh. Predetermined Rates.
ii. Per Member per Month (PMPM).
jj. Preferred Provider Organization (PPO).
kk. Premiums.
ll. Price Setter.
mm. Primary Care Provider (PCP).
nn. Point-of-service Plan (POS).
oo. Prospective Payment System (PPS).
pp. Retrospective Payment.
qq. RBRVS (Resource Based Relative Value System).
rr. RVU.
ss. Staff Model HMO.
tt. Steerage.
uu. Stop Loss.
vv. Subcapitation.
ww. The First Party.
xx. The Second Party.
yy. The Third Party.
zz. Usual, Customary, and Reasonable Charges.
aaa. Zero-based Budget (Capitation).