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PoHR: Chapter 7

Principles of Healthcare Reimbursement: Chapter 7 Key Terms

TermDefinition
GPCI geographical practice cost index
RBRVs resource-based relative value
ASC ambulatory surgical center
RVU relative value unit
CF conversion factor
PE physician practice expense
WORK physician work
MP malpractice
PLI professional liability insurance
MPFS or PFS medicare physician (provider) schedule fee
SGR sustainable growth rate
BN budget neutrality
PQRS physician quality reporting system
EP elegible professionals
CAH critical access hospital
APC ambulatory payment classifications
AIRR all inclusive reimbursement rate
ASC LIST ambulatory surgery center list of covered procedures
BN ADJUSTOR budget neutrality adjustor
BUNDLING combination of supply and pharmaceutical costs or medical visits with associated procedures or services for one lump sum payment
CY calendar year
FQHC federally qualified health center
MAC medicare administrative contractor
OCE outpatient coding editor
RHC rural health clinic
ANCILLARY SERVICES professional healthcare services such as radiology, laboratory, or physical therapy
ASSIGNMENT OF BENEFITS a contract between a physician and medicare in which the physician agrees to bill medicare directly for covered services, to bill the beneficiary only for any coinsurance or deductible that may be applicable, and to accept the medicare payment as payment
CARRIER entity that has a contract with the centers for medicare and medicaid services (CMS) to determine and make medicare payments for part b benefits
CRITICAL CARE SERVICES evaluation and management of critically ill or critically injured patients
DISCOUNTED FEE-FOR-SERVICE
HOLD HARMLESS STATUS
ELECTRONIC PRESCRIBING
EPISODE OF CARE
HOSPICE
ELECTRONIC PRESCRIBING INCENTIVE PROGRAM
MARKET BASKET
NATIONAL UNADJUSTED COPAYMENT
NATIONAL UNADJUSTED PAYMENT
Created by: jacquelinerose