Controlling Costs and Changing Patient Care? The Role of Utilization Management (1989) / Chapter Skim
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Appendix G - Glossary and Acronyms
Appendix G - Glossary and Acronyms
Pages 288-292
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From page 288... ...
Claim: A bill for health services submitted to a health benefits plan for payment. Coinsurance: The percentage of a covered medical expense that a beneficiary must pay (after the deductible is paid)
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From page 289... ...
Gatekeeper: Primary care provider who is responsible for coordinating all medical treatment rendered to an enrollee of a health plan. Group Model Health Maintenance Organization: A health maintenance organization that contracts with a primary care or multispecialty medical practice for delivery of health services.
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From page 290... ...
: A physician-based organization that reviews the medical necessity and the quality of care provided to Medicare beneficiaries. Per Diem: A negotiated daily payment for delivery of hospital services, regardless of the actual services provided; sometimes refers only to "room and board" charges (meals, routine nursing care, etc.)
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From page 291... ...
involved in the financing of personal health services. [riple-Option Plan: An experience-rated program for an employer group in which a single insurance carrier, Blue Cross and Blue Shield plan, or health maintenance organization provides indemnity or service benefits in conjunction with various managed care or health maintenance organization plans.
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From page 292... ...
Department of Health and Human Services DRG: Diagnosis-related group FFS: Fee-for-service FMC: Foundation for Medical Care GAO: U.S. General Accounting Office GHAA: Group Health Association of America HCFA: Health Care Financing Administration HERA: Health Insurance Association of America HMO: Health maintenance organization ICD-9: Intemational Classification of Disease IMC: International Medical Centers Inc.
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Key Terms
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