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CHAPTER 17 Insurance

Medical Terminology

TermDefinition
Admission Review: A review for appropriateness and necessity of admission.
Ambulatory Payment Classification (APC): A system of outpatient hospital reimbursement based on procedures rather than diagnoses
Appropriateness Evaluation Protocol (AEP): Nineteen criteria for admission under the prospective payment system, separated into two categories: severity and intensity of illness.
Capitationm System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided.
Case Rate: An averaging after a flat rate is given to certain categories or procedures
Charge Description Master (CDM): A computer program that is linked to various
Created by: asusy702
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