10 Terms
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Managed care
A health care practice intended to streamline services and provide high quality, cost-effective care.
Industry: Health care
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Managed care
eqro organization
Health care; Managed care
Federal law and regulations require states to use an external quality review organization (EQRO or QRO) to review the care provided by capitated managed care entities. EQROs may be peer review ...
stark bill
Health care; Managed care
Federal law that prevents physicians from Medicare patients to entities which they or their immediate family have a vested financial interest, and bars doctors from referring Medicare patients for 11 ...
Medicaid and Medicare Patient and Program Protection Act
Health care; Managed care
Federal law, since 1987, that enacts criminal penalties against a person who knowingly offers, pays, solicits, or receives payment to encourage services or a medical item for which payment is made by ...
Social Security Act
Health care; Managed care
Federal legislation providing social insurance on a national scale.
HMO Act of 1973
Health care; Managed care
Federal legislation requiring all employers with traditional health insurance benefits to offer HMO benefits.
physician professional component expenses
Health care; Managed care
Fees paid to hospital-based physicians and residents for services provided for direct patient care.
malingering
Health care; Managed care
Feigning a disability to collect health insurance benefits, especially following a recovery from a covered disability.
