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Definition
| Supportive service other than routine hospital provided by the facility (ie X-Ray and laboratory) |
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Term
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Definition
| A physician's justifying the transferance of sick, or high cost patients to other physician in a managed care plan. |
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Definition
| A system o fpayments used in managed care plans in which physicians and hospital are paid a fixed per capita amount for each patient enrolled over a stated period of time, regardless of the type and number of services provided. |
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Definition
| A primary care physician informs thepatient and telephones to the referring physician that the patient is being referred for an appointment. |
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Term
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Definition
A process based on established criteria of reviewing and controlling the medical necessity for services and providers use of medical care resources. Review are carried out by allied health personnel at predetermined times during the hospital. In managed care systems such as an HMO, reviews are done to establish medical necessity, thus curbing costs. AKA utilization or management control |
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Term
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Definition
Transferring the sickest and high cost patients to other physicians so the provider appears as a low-utilizer in a manage care system. |
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Definition
Services requested by a specialist from another specialist (ie neurosurgeons, thoracic surgeons and intensive care units) |
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Definition
When physician see a high volume of patients more than medically necessary to increase revenue. May be seen in a fee for service or managed care environments. |
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Term
| Claims review type of foundation |
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Definition
| a type of review that provides peer review by physicians to the numerour fiscal agents or carriers in voloved in it's area. |
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Term
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Definition
| A form of HMO that limits the patients choice of person physicians to those doctors practicing in the HMO group practice within the geographic location of the facility. A physi must meet very narrow criteria to be a part of a closed panel program. |
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