Term
| clinical/critical pathway (definition) |
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Definition
| a standardized recommended intervention protocol for a specific diagnosis |
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Term
| fee for service (description) |
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Definition
| the payment system under which the provider is paid the same type of rate per unit of service (traditionally, payer pays 80% and patient or provider is responsible for maintaining 20%) |
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Term
| diagnostic related groups (DRGs) (definition) |
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Definition
| the descriptive categories established by CMS that determine the level of payment at a per case rate |
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Term
| managed care (definition) |
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Definition
| a method of maintaining some control over costs and utilization of services while providing quality health care (typically refers to HMOs and PPOs) |
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Term
| prospective payment system (PPS) (definition) |
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Definition
| the nationwide payment schedule that determined the Medicare paymetn for each inpatient stay of a Medicare beneficiary based on DRGs |
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Term
| usual and customary rate (UCR) (definition) |
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Definition
| the average cost of specific health care procedures in a geographic area. This is the maximum amount the insurer will pay for a service and covered expense. |
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