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Flashcards (Term/Definition) for Management of Health Service: CRG=clinical risk group, Quizzes of Management of Health Service

is a prospective payment system that predicts future health care expenditures Class: HSA - Management of Health Service; Subject: Health Services Administration; University: Pennsylvania College of Technology; Term: Forever 1989;

Typology: Quizzes

2010/2011

Uploaded on 01/10/2011

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TERM 1
fee schedule
DEFINITION 1
is a predetermined list of fees that the third party payer
allows for payment of all health care services
TERM 2
allowable fee
DEFINITION 2
represents the average or maximum amount the third party
payer will reimburse providers for the service.
TERM 3
UCR
DEFINITION 3
usual, customary, and reasonable defined as usual in the
providers practice ;customary in the community, and
reasonable for the situation. one method of payment within
the type of traditional retrospective system
TERM 4
CPR
DEFINITION 4
customary, prevailing and reasonable
TERM 5
RBRVS
DEFINITION 5
Resource-Based Relative Value Scale (RBRVS) is a schema
used to determine how much money medical providers
should be paid. Version of a discounted fee for service
payment method
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fee schedule

is a predetermined list of fees that the third party payer allows for payment of all health care services TERM 2

allowable fee

DEFINITION 2 represents the average or maximum amount the third party payer will reimburse providers for the service. TERM 3

UCR

DEFINITION 3 usual, customary, and reasonable defined as usual in the providers practice ;customary in the community, and reasonable for the situation. one method of payment within the type of traditional retrospective system TERM 4

CPR

DEFINITION 4 customary, prevailing and reasonable TERM 5

RBRVS

DEFINITION 5 Resource-Based Relative Value Scale (RBRVS) is a schema used to determine how much money medical providers should be paid. Version of a discounted fee for service payment method

Risk pool

A risk pool is one of the forms of risk management mostly practiced by insurance companies. Group of persons has similar risks of loss TERM 7

Reimbursement

DEFINITION 7 health care term that refers to the compensation or repayment of health care services TERM 8

Fee schedule

DEFINITION 8 is a predetermined list of fees that the third party payer allows for payment for all health care services. TERM 9

Allowable Fee

DEFINITION 9 represents the average or maximum amount the third party payer will reimburse providers for the service. TERM 10

Capitation

DEFINITION 10 Capitation, in the context of health care systems, is a method of paying health care service providers (e.g., physicians). 3rd party payer reimburses providers a fixed per capita amount for a period. part of episode of care