| I |
| Incurred
But Not Reported (IBNR) |
Top |
Refers
to claims that reflect services already
delivered, but, for whatever reason, have not
yet been reimbursed. These are bills "in
the pipeline." This is a crucial concept
for proactive providers who are beginning to
explore arrangements that put them in the role
of adjudicating claims--as the result, perhaps,
of operating in a sub-capitated system (see
below). Failure to account for these potential
claims could lead to some very bad decisions.
Good administrative operations have fairly
sophisticated mathematical models to estimate
this amount at any given time. |
| Indemnity
Carrier |
Top |
Usually
an insurance company or insurance group that
provides marketing, management, claims payment
and review, and agrees to assume risk for its
subscribers at some pre-determined rate. |
| Indemnity
Plan (Indemnity health insurance) |
Top |
A
plan which reimburses physicians for services
performed, or beneficiaries for medical expenses
incurred. Such plans are contrasted with group
health plans, which provide service benefits
through group medical practice. |
| Independent
Physician Association (IPA) |
Top |
Contracts
with individual physicians who see HMO members,
as well as their own patients, in their own
private offices. It is the ability of IPA
physicians to see both IPA and private patients
in their own offices that principally
differentiates an IPA from a group or staff HMO.
Physicians in an IPA are paid either on a
capitation or a modified fee-for-service basis. |
| Individual
Plans |
Top |
A
type of insurance plan for individuals and their
dependents that are not eligible for coverage
through an employer group (group coverage). |
| Individual
Practice Association (IPA) |
Top |
An
HMO model in which the HMO contracts with a
physician organization that in turn contracts
with individual physicians. The IPA physicians
provide care to HMO members from their private
offices and continue to see their
fee-for-service patients. |
| Inpatient
Care |
Top |
Care
given a registered bed patient in a hospital,
nursing home or other medical or post acute
institution. |
| Internal
Medicine |
Top |
Generally,
that branch of medicine that is concerned with
diseases that do not require surgery,
specifically, the study and treatment of
internal organs and body systems; it encompasses
many subspecialties; internists, the doctors who
practice internal medicine, often serve as
family physicians to supervise general medical
care. |
| International
Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) |
Top |
The
World Health Organization's ninth edition of its
book used widely for hospital diagnoses. A 10th
version recently has been released. You may read
about fee structures that are designed along the
lines of ICD-9 codes. |
