Section 4 Continuity of Care

Continuity of Care (COC)

long term care like chronic illnesses, concern of quality of car eovertime which is a process that is patient and provider led.

Primary Care Provider (PCP)

Provider that sees patients with common medical problems like NP, GP, FP, and PA

Health Insurance

type of insurance coverage that helps pay for medical and surgial expenses, insurance may reimburse patient or pay facility/provider directly

Copayment (Copay)

payment made by pt in addition to insurance payment

deductible

specificied amount of money that the pt will pay out of pocket before insurance will pay for a claim

provider network

providers, hospitals, facilities, etc agree to the terms of the insurance co. to provide care for their customers

HMO

Health Maintanence Organization, LEAST cost for pt, no/low cost copay, need referral for specialist

PPO

Preferred Provider Organization, MORE expensive for pt, any provider you choose

EPO

Exclusive Provider Organization, lowest out of pocket, stick with organization provider unless emergency

Role of the Patient

Self advocate, active members of their team, weigh in an decision making, plans and assessment of progress. pt cant decline anytime.

Role of the Provider

May be part of care team by choice or necessity. Earn respect and trust of patient and make sure to educate the patient and get true informed consent. Transferring care should be helped with ease.

Role of the community

pt’s family, friends, co-workers, reliigoius affiliations, and local insiutions help support and encourage patient

Role of Medical Assisstant

Educate, encourage, and support. Give resources in local community

AIDET (Simpler version of patient care values)

Acknowledge, Introduce, Duration, Explaination, and Thank You

Encounter Form (Superbill)

A list of diagnoses, procedures, and charges for a patients visit

Patient Care Encounter Form

summary based on interaction between a provider and the patient and the treatment plan established during specific visit

Parts of the Superbill

Provider’s Information, Patient’s Information, Service Information, and Additional Information

CMS-1500 (HCFA-1500) Form

Standard paper claim form to bill Medicare Fee for Service Contractors when paper is allowed

UB-04 Form (CM 1450)

Form designed to bill an insituional provider

ABN

Advanced Beneficiary Notice of Noncoverage which is a form that allows a patient to acknowledge consent to have testing performed with the knowledge that Medicare may or may not pay

Medicare Part A

Provides medical coverage for inpatient hospitalization, home health, hospice, and nursing home facilities

Medicare Part B

Provides medical coverage for outpatient outpatient care treatments, medical equipment, and laboratory testing

Medicare Part C (Medicare Advantage Plan)

This plan is for individuals who meet the qualitfication of coverage under Medicare A and B

Medicare Part D

Provides prescription drug coverage for individuals covered under medicare

Medicaid

Government-provided insurance for low income and/or disabled individuals

Medicare

Government-provided insurance for disabled and/or over 65 years of age

DOS

date of service