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Reimbursement5
Managed Care
Question | Answer |
---|---|
Capitation | Method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount for each person enrolled without regard to the actual number or nature of services provided or number of persons served. |
Carve-out | Contracts that separate out services or populations of patients or clients to decrease risk and costs. |
Case Management | Coordination of individuals' care over time and across multiple sites and providers, especially in complex and high-cost cases. Goals include continuity of care, cost-effectiveness, quality, and appropriate utilization |
Cherry-picking | Targeting the enrollment of healthy patients to minimize healthcare costs. |
Closed panel | Type of health maintenance organization that provides hospitalization and physicians' services through its own staff and facilities (staff or group model) |
Community rating | Method of determining healthcare premium rates by geographic area rather than by age, health status, or company size. |
Cost sharing | Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism. |
Disease management | |
Dual eligivle | |
Enrollee | |
Episode-of-care reimbursement | |
Evidence-based clinical practice guidelines | |
Exclusive provider organization (EPO) | |
Fee-for-service reimbursement | |
Formulary | |
Gatekeeper | |
Global payment | |
Group practice model |