Examlex
What were some of the problems with private pension that led to regulation with the passage of ERISA in 1974?
Capitation
The health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization regardless of whether services were provided.
Precertification
Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.
Specified Outpatient
Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.
Coordination of Benefits (COB)
A process in health insurance to determine the order of responsibility when a person is covered by more than one insurance plan, to avoid overlapping payments.
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