Change or modification applied to payments under the prospective payment system (PPS) for hospitals that operate approved graduate medical education programs. For operating costs, the adjustment is based on the hospital’s ratio of interns and residents to the number of beds. For capital costs, the adjustment is based on the hospital’s ratio of interns and residents to average daily occupancy.

Association or connection between an individual and a health care provider in which the provider delivers care to the patient based on orders from another physician and the provider either gives services and supplies, reports diagnoses, or provides results directly to another provider who interacts with the patient. For example, a radiologist or a pathologist would be considered to have indirect treatment relationships with patients because they provide diagnostic services requested by other providers and furnish results to the patient through the direct treating physician.

Under the Health Insurance Portability and Accountability Act (HIPAA), the person who is the subject of protected health information.

Retirement plan that is funded in accordance with a formula based on a certain percentage of the participant’s compensation.

Insurance claim that must be reviewed because of an unusual, unique, or variation from standard medical service to determine the benefit or payment allowance.

Name of a segment of the insurance market of single employers that provide insurance coverage for their employees through a master contract that is issued to the employer.

Type of medical insurance fraud that is committed by individuals on their insurance claims so that they can obtain benefits in excess of their medical expenses. Also see provider fraud and fraud .