Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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 |
Created by:
Lyn Slough
Popular Medical sets