Fee Schedules
Capitation Fee
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
Relative Value Scales
Coded listings of physician or other professional services using units that indicate the relative value of the various services they perform. They take into account time, skill, and overhead cost required for each service, but generally do not consider the relative cost-effectiveness. Appropriate conversion factors can be used to translate the abstract units of the relative value scales into dollar fees for each service based on work expended, practice costs, and training costs.
Prescription Fees
Medicare Assignment
Concept referring to the standardized fees for services rendered by health care providers, e.g., laboratories and physicians, and reimbursement for those services under Medicare Part B. It includes acceptance by the physician.
Medicare Part B
The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
Financing, Personal
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Hospital Charges
The prices a hospital sets for its services. HOSPITAL COSTS (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care.
Insurance, Health, Reimbursement
Durable Medical Equipment
Economics, Medical
Uncompensated Care
Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.
Inflation, Economic
Cost Sharing
Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)
Private Practice
Competitive Bidding
Insurance, Physician Services
Centers for Medicare and Medicaid Services (U.S.)
Insurance, Surgical
Health Expenditures
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
United States
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Medicaid
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
Environmental Policy
A course of action or principle adopted or proposed by a government, party, business, or individual that concerns human interactions with nature and natural resources.
Privatization
Process of shifting publicly controlled services and/or facilities to the private sector.
Current Procedural Terminology
Descriptive terms and identifying codes for reporting medical services and procedures performed by PHYSICIANS. It is produced by the AMERICAN MEDICAL ASSOCIATION and used in insurance claim reporting for MEDICARE; MEDICAID; and private health insurance programs (From CPT 2002).
Medicare
Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
Health Care Reform
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
Prospective Payment System
Health Care Costs
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Insurance, Liability
Nepal
I'm sorry for any confusion, but "Nepal" is not a medical term that has a definition in the field of medicine. It is actually the name of a country located in South Asia, known officially as the Federal Democratic Republic of Nepal. If you have any questions related to medicine or health, I would be happy to try and help answer those for you!
Burkina Faso
Cambodia
I'm sorry for any confusion, but "Cambodia" is not a medical term that can be defined in a medical context. It is the name of a country located in Southeast Asia, known officially as the Kingdom of Cambodia. If you have any questions related to health, medicine, or science, I'd be happy to try and help answer those for you.
Patient Credit and Collection
Public Policy
Salaries and Fringe Benefits
The remuneration paid or benefits granted to an employee.
Physician Incentive Plans
Compensatory plans designed to motivate physicians in relation to patient referral, physician recruitment, and efficient use of the health facility.
Burundi
Health Services Research
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
Health Policy
Employee Incentive Plans
Nature
Cost Allocation
Efficiency, Organizational
Copying Processes
Afghanistan
Rural Health Services
Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
Patient Protection and Affordable Care Act
An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.
Cost Control
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
Social Justice
National Health Programs
Drug Costs
The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).
Lawyers
Poverty
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.
Single-Payer System
An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs. (From Slee and Slee, Health Care Reform Terms, 1993, p106)
Utilization Review
Office Visits
Hospital Costs
The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).
Mali
A country in western Africa, east of MAURITANIA and south of ALGERIA. Its capital is Bamako. From 1904-1920 it was known as Upper Senegal-Niger; prior to 1958, as French Sudan; 1958-1960 as the Sudanese Republic and 1959-1960 it joined Senegal in the Mali Federation. It became an independent republic in 1960.
Cost Savings
Surgicenters
Fraud
Developing Countries
Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.
Training Support
Policy Making
Zimbabwe
Education, Dental, Graduate
Educational programs for dental graduates entering a specialty. They include formal specialty training as well as academic work in the clinical and basic dental sciences, and may lead to board certification or an advanced dental degree.
Maryland
I'm sorry for any confusion, but the term "Maryland" is not a recognized medical term with a specific definition in the medical field. It refers to a state in the United States. If you have any questions about a medical condition or treatment, I would be happy to try and help answer those!
Health Services Needs and Demand
Models, Econometric
Honduras
Delivery of Health Care
Fiber Optic Technology
Togo
A republic in western Africa, lying between GHANA on its west and BENIN on its east. Its capital is Lome.
Managed Care Programs
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Hospitals, District
Fees, Pharmaceutical
Insurance, Health
Hospitals, Public
Obstetrics
Deglutition Disorders
Cost-Benefit Analysis
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
Models, Economic
Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.
Prepaid Health Plans
Delivery, Obstetric
Diagnostic Services
Quality of Health Care
Data Collection
Primary Health Care
Hazardous Waste
Research Report
Diagnosis-Related Groups
A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.
Community Health Services
Practice Management, Medical
Insurance Selection Bias
Drug and Narcotic Control
Equipment and Supplies
Insurance Coverage
Licensure
The legal authority or formal permission from authorities to carry on certain activities which by law or regulation require such permission. It may be applied to licensure of institutions as well as individuals.
Time and Motion Studies
Healthcare Common Procedure Coding System
Government Programs
Ontario
A province of Canada lying between the provinces of Manitoba and Quebec. Its capital is Toronto. It takes its name from Lake Ontario which is said to represent the Iroquois oniatariio, beautiful lake. (From Webster's New Geographical Dictionary, 1988, p892 & Room, Brewer's Dictionary of Names, 1992, p391)
Reimbursement, Incentive
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
United States Food and Drug Administration
Ambulatory Care Facilities
Malpractice
Ophthalmology
Health Resources
Drugs, Investigational
Physician's Practice Patterns
Ghana
Private Sector
Ambulatory Care
Professional Practice Location
Geographic area in which a professional person practices; includes primarily physicians and dentists.
Pharmaceutical Preparations
Certification
Compliance with a set of standards defined by non-governmental organizations. Certification is applied for by individuals on a voluntary basis and represents a professional status when achieved, e.g., certification for a medical specialty.
Cost of Illness
The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.