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Show GLOSSARY OF TERMS COMMONLY USED IN HEALTH CARE (Excerpts from Glossary of Terms Commonly Used in Health Care. Printed with permission from Alpha Center, 1350 Connecticut Avenue, N.W., Suite 1100, Washington, D.C. 20036) B Activities of Daily Living (ADL) An index or scale which measures a patient's degree of independence in bathing, dressing, using the toilet, eating, and moving from one place to another. acute care Medical treatment rendered to individuals whose illnesses or health problems are of a short-term or episodic nature. Acute care facilities are those hospitals that mainly serve persons with short-term health problems. adverse selection A tendency for utilization of health services in a population group to be higher than average. From an insurance perspective, adverse selection occurs when persons with poorer-than-average health status apply for, or continue, insurance coverage to a greater extent than do persons with average or better health expectations. ambulatory care All types of health services which are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay. any willing provider laws Laws that require managed care plans to contract with all health care providers that meet their terms and conditions. balance billing In Medicare and private fee-for-service health insurance, the practice of billing patients for charges that exceed the amount that the health plan will pay. Under Medicare, the excess amount cannot be more than 15 percent above the approved charge. capitation A method of payment for health services in which an individual or institutional provider is paid a fixed amount for each person served, without regard to actual number or nature of services provided to a person in a set period of time. Capitation is the characteristic payment method in certain health maintenance organizations. It also refers to a method of Federal support of health professional schools. Under these authorizations, each eligible school receives a fixed payment, called a "capitation grant" from the Federal government for each student enrolled. carve out Regarding health insurance, an arrangement where an employer eliminates coverage for a specific category of services (e.g., vision care, mental health/psychological services and prescription drug) and contracts with a separate set of providers for those services according to a predetermined fee schedule or capitation arrangement. Carve out may also refer to a method of coordinating dual coverage for an individual. 133 |
