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 W Suite 1100 Washington C 20036 Activities of Daily Li 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 An index or scale which measures patientdegree of independence in bathing dressing using the toilet eating and moving from one place to another acute care Medical treatment rendered to individuals whose ilinesses or health problems are ofshort-term or episodic nature Acute care faciliies are those hospitals that mainly serve persons with short-term health problems capitation method of payment for health services in which an individual or institutional provider adverse selectiontendency for utilization of health services is paidfixed amount for each person inpopulation group to be higher than served without regard to actual number or nature of services provided toperson in average From an insurance perspective set period of time Capitation is the adverse selection occurs when persons with poorer-than-average health status apply for or continue insurance coverage togreater 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 tolocation to receive services which do not require an overnight stay characteristic payment method in certain health maintenance organizations It also refers tomethod of Federal support of health professional schools Under these authorizations each eligible school receives afixed payment called capitation grant from the Federal government for each student enrolled carve out Regarding health insurance an arrangement where an employer eliminates coverage forspecific category of services g vision care mental health psychological services and prescription drug and contracts with any willing provider laws separate set of providers for those services according topredetermined fee schedule Laws that require managed care plans to contract with all health care providers that also refer tomethod of coordinating dual meet their terms and conditions or capitation arrangement Carve out may coverage for an individual 159 Digital image 2005 Marriott Library University of Utah Al rights reserved |