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HCFA 1500: Refers to a universal form developed by the Health Care Financing Administration and is for all service providers who bill their professional fees to insurance carriers.
HCFA Common Procedural Coding System (HCPCS): The list of services, supplies, and procedures that physicians offer their patients. This coding system is represented by current procedural terminology, national alpha-numeric codes, and local alpha-numeric codes.
Health Alliances: Refers to groups or other entities who negotiate with insurance carriers to provide health coverage at competitive pricing to alliance members.
Health Benefits Package: Refers to health plan coverage and services for a covered individual or group.
Health Care Delivery System: This system includes doctors, hospital facilities, and ancillary providers that contract in order to deliver medical services to members.
Health Care Financing Administration (HCFA): Refers to the federal agency that administers Medicare and oversees each state's handling of Medicaid.
Healthcare Prepayment Plan (HCPP): Refers to the cost contract with the Health Care Financing Administration that supplies pre-payment of a health insurance plan's flat per-month account in order to provide Medicare Part B services to enrollees.
Health Coverage: Refers to the payment of benefits for injuries or illnesses covered by the insured's policy. This coverage may refer to medical, dental, vision care, or other coverage benefits. Health History: Medical-related information that is used by insurance underwriters when assessing the medical history of applicants to determine eligibility and acceptable risk.
Health Insurance Portability and Accountability Act (HIPAA): HIPAA is a federal law that seeks to improve the availability of health insurance coverage as well as to improve the continuity of health insurance. The law places limits on items such as pre-existing conditions and also allows some people to enroll for group coverage when they lose their current health insurance coverage or have a new dependent that requires coverage. HIPAA prohibits discrimination in a group insurance plan due to health status.
Health Insurance Purchasing Cooperatives (HIPC): These are purchasing pools that take responsibility for negotiating with insurers for groups who join voluntarily. Alliances are able to use their leverage to negotiate for improved rates for its members. Some cooperatives are state organized while others are privately organized.
Health Maintenance Organization (HMO): An organization that arranges medical coverage for plan members at a fixed premium that is prepaid. HMOs follow four types of models that include a network model, group model, staff model, and individual practice association. According to legislation, HMO practices must meet regulatory standards. To call itself an HMO, the organization must: A. Provide healthcare services in a specified geographic area. B. Agree on basic and supplemental treatment offerings. C. Voluntary enrollees
Health Plan: Refers to a health insurance plan, health maintenance organization, self-funded insurance plan, preferred provider organization, or some other arrangement that provides healthcare benefits.
Health Plan Employer Data and Information Set (HEOIS): Refers to a set of core performance measures that are handled by the National Committee for Quality Assurance in order to help employers evaluate the performance of their health insurance plan. This set is also used by the HCFA in order to monitor the deliver and quality of care provided by managed care organizations.
Health Plan Purchasing Cooperatives - See Health Insurance Purchasing Cooperatives
Health Service Agreement (HSA): A component of a High Deductible Health Plan. You may not have an HSA unless you are already enrolled in an HDHP. An HSA is an account that an individual owns. Its purpose is for paying qualified medical expenses for oneself and one's dependents. There are various means for funding an HSA, including: Voluntary contributions in accordance with IRS limits; Make a voluntary contribution to an IRS-approved trustee who administers the HSA; Make pre-tax allotments via a federal flexible benefits plan.
Eligibility Standards for a Health Savings Account: Enroll in an HDHP for HSA eligibility. Individuals may not be eligible for an HSA if: A. You are enrolled in Medicare B. Covered in an alternate health insurance plan that is not an HDHP C. Claimed as a dependent a person's tax return D. Are an enrollee of a Healthcare Flexible Spending Account E. Covered by VA benefits or a non-HDHP F. You have been determined ineligible for an HSA If you do not meet the requirements for an HSA, your HDHP will develop a Health Reimbursement Arrangement. If you have an HSA, your voluntary contributions will be recorded as a tax deduction. These contributions may earn tax-free interest that can also be used for a qualified medical expense. Individuals can also use this interest for non-medical expenses; however, there is a 10% tax deduction associated with these expenses.
High Deductible Health Plan: This is a type of health plan that is attached to a high minimum deductible that does not offer coverage for initial costs or all medical costs. The insured must provide the initial payment of medical expenses before the coverage begins to apply. The minimum deduction varies from year to year.
Hospice: Providers of palliative and / or supportive care for the terminally ill. Hospice care providers must be licensed or certified in accordance with local or state laws where their services are required.
Hospital Affiliation: Refers to the contracted relationship between one or more hospitals and a health plan.
Hospital Alliance: Refers to networked hospitals that have voluntarily banded together to reduce expenses and share some common services. They may also take advantage of group purchasing programs to enhance their cost savings.
Human Risk Management: Refers to a service used to reduce demand for treatment through identification, assessment, and the management of a person's health risks before treatment becomes a necessity.
Human Resource Administration (HRA): Refers to the management of personnel in an industry or an organization. Historically referred to as personnel management, human resources staffs work to improve the employment experience of employees and help the administration meet its business or organization goals in regard to employee management. The human resources team also usually handles recruitment, payroll, and the administration of benefits.