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4010 wk 3


buffing a physicians justifying the transference of sick, high-cost patients to other physicians in a managed care plan
capitation a 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 of time
carve outs medical services not included within the capitation rate of a managed care contract and may be contracted seperately
churning when pysicians see a high volume of patients more then medical necessary to increase revenue
copayment a patients payment of a portion of the cost at the time of service is rendered
deductible a specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins converting health care costs
direct referral authorization request form is completed and signed by the physican and handed to the patient to be done directly
gatekeeper in a managed care system, this is the physicans who controls the patients access to speacialists and diagnostic services
particippating physician a physician who contracts with an HMO or other insurance company to provide services who have agreed to accept a plan payment
tertiary services requested by a specialist from another specialist
v codes health care encounters that occur for reasons other than illness or injury
e codes
Created by: secretsluv