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Managed Care Organizations (MCOs)

Chapter 6- Payment Methods and Checkout Procedures
Across
Billing the patient for the difference between the allowed charge and the physician's fee schedule
Another name for a HDHP
Traditional plan
Payments that are due at the time of service
Patient pays a fixed amount at each visit
Person who cannot afford to pay their medical bills
Practice's rules governing payment from patients.
Most popular type of MCO
Gatekeeper of services
Fixed payment based on head count versus visits
Patients may not seen specialist without permission from their PCP
Patient with no insurance
Physician price list
Down
PAR agreement to accept allowed charge as payment in full
Patient pays a percentage of the bill
In network provider
Form Given to the patient at the end of each visit includes charges and payments
Single payment for a full episode of care- price includes precare, care and post care.
Plan features include a low premium but high deductible
Oldest type of MCO
Superbill
Patients may see in or out of network providers
Annual amount that must be paid before insurance begins to pay provider
Maximum charge an insurance plan will pay for a service
Out of network provider
Adjustment
Combination of an HMO and PPO