1. Policy of setting fees equal or slightly below a competitor’s fees. This may tend to maximize profits but will raise medical costs and is generally considered to be unethical. 2. In an employer group’s managed care plan, to price premiums based on the cost of indemnity insurance instead of following community or experience rating standards.

Duplicate of an original medical record in hard copy, scanned for an electronic file, or downloaded from primary information systems. It is retained for the convenience of a department or health care provider.

Practice used to improve clinical documentation in a facility in which a nonphysician clinician/documentation expert is paired with a physician for 1 day of patient care. At the end of the day, the two practitioners compare notes on what should have been documented based on what the physician did for each patient.

The amount the patient must pay each month before he or she can be eligible for Medicaid. Also known as liability or spend down .

Arrangement in a managed care plan in which the provider and health plan share the risk for excessive utilization and/or excessive costs of plan members. It is used to give financial incentive to managed care providers for giving cost-effective, high-quality care. Also called risk sharing or risk pool.

Insurance provision of managed care plans in which a portion of the providers’ income is linked to the financial performance of the plan. When costs are lower than predicted, a percentage of the savings is given to providers.