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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
