Key terms Crossword
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
                                                  
 
 
Down: 1) Sometimes called individual practice organization or IPO; a legal entity, comprised of a network of private practice providers, who have organized to negotiate contracts with insurance companies and HMO's4) A patient's verbal expressions regarding quality of services, access to care, or their relationship with their provider5) Provider who chooses not to contract with a preferred provider organization (PPO).7) A system for organizing the delivery of health services so that the cost of care is reduced and the quality of care is maintained or improved.8) Written complaints made by a member regarding quality of services, access to care, interpersonal communication, any other aspect of care, or relationship with the provider. Across: 2) Instead of paying monthly premiums to an insurance carrier, employers place the money in an escrow account; when an employee receives medical attention, the claim is submitted to the employer and is reimbursed according to the terms of the employer's contract3) Lists patients whose coverage has continued into the next month6) Assists the provider in determining who is eligible for treatment; lists those patients who have chosen the provider as their primary care provider (PCP).9) The practice of paying a provider a set amount per month to provide treatment to managed care plan members and for performing other administrative duties.10) Shows those patients who have signed up for MCP coverage and have chosen the provider as their PCP. In addtion to members who have just begun coverage, the new member roster shows those existing patients who have recently chosen this provider as their PCP11) Also known as stop-loss insurance; an insurance policy that protects the company against catastrophic medical costs levied against its plan, either by a single employee or by all employees as a whole12) Shows those members whose coverage has been terminated or who have chosen to terminate a certain provider as the PCP.13) The second most common managed care alternative where the insurance carrier contracts with providers to provide services at a contracted rate.14) A specific provider chosen by the plan member for care: also called a primary care physician15) An attempt to limit payments by an insured person, or a provider/group/IPA, in the case of a catastrophic illness or injury to a member.16) A seperate corporation set up to provide management services to a medical group for a fee.17) When a patient transfers care from a provider.18) A portion of the monthly capitation amount that the managed care plan (MCP) may retain to protect the Health Maintenance Organization (HMO) from inadequate patient care of financial management by the primary care provider (PCP)19) Providers who are contracted by a preferred provider organization (PPO) to provide services.20) Basically a much smaller Physician Provider Organization (PPO) where the patient must select a primary care provider (PCP) and can use only those providers who are part of the network or who are referred by the PCP21) Also known as a Medicare HMO; an organization that provides the full range of Medicare benefits offered by standard HMOs plus addtional services22) An organization of providers and hospitals that band together for the purpose of obtaining contracts from payer organizations
 

 

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