20 Terms
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General
General nature or nature terms.
Industry: Natural environment
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General
Pharmacy benefit manager (PBM)
Health care; General
PBMs are third party administrators of prescription drug benefits.
Rehabilitation
Health care; General
Rehabilitative services are normally ordered by a doctor to help a patient recover from an illness or injury. These services are given by nurses and physical, occupational, and speech therapists. ...
Physician attestation
Health care; General
The requirement that the attending physician certify, in writing, the accuracy and completion of the clinical information used for DRG assignment.
Reinsurance
Health care; General
An insurance arrangement whereby the MCO or provider is reimbursed by a third party for costs exceeding a pre-set limit, usually an annual maximum. A method of limiting the risk that a provider or ...
Physician contingency reserve (PCR)
Health care; General
Portion of a claim deducted and held by a health plan before payment is made to a capitated physician. Revenue that is withheld from a provider's payment to serve as an incentive for providing less ...
Relative value scale (RVS)
Health care; General
An index assigning various weights to various medical services. Each weight represents a relative amount to be paid for each service. The RVS used in the development of the Medicare Fee Schedule for ...
Physician current procedural terminology (CPT)
Health care; General
List of services and procedures performed by providers, with each service/procedure having a unique 5-digit identifying code. CPT is the health care industry's standard for reporting of physician ...
