Rider included in a dental insurance policy that encourages regular dental care by stating that the insurance company will pay a higher percentage of dental expenses if the insured obtains regular dental examinations for preventive maintenance.

Financial motivators offered to providers to help encourage efficiency and quality of health services and its delivery such as managed care contract agreements that offer profit-sharing, pooling, withhold pool, bonus pool, or risk pool. Arrangements are used to persuade physicians to decrease patients’ hospital days, increase preventive health services, and consider alternative treatment.

Frequency of new occurrences of a medical condition within a defined time interval. The incidence rate is the number of new cases of specific disease divided by the number of people in a population over a specified period of time, usually 1 year.

Rate of new cases of a disease or health condition in a specified population over a defined period. To calculate an incidence rate, look at the number of new cases occurring in a population that is at risk for getting the disease over a specific time period.

Right to exercise any insurance policy privilege such as right to change the beneficiary, cancel or surrender a policy, assign the policy, obtain a policy loan, or use the policy as collateral for a loan.

1. In the Medicare program, billing for medical services provided by an employee of a provider who is a nurse, physician’s assistant, anesthetist, psychologist, technician, occupational therapist, or physical therapist. The services and supplies must be furnished under the direct supervision of the physician or other practitioner. The physician or other practitioner directly supervising the auxiliary personnel need not be the same physician or other practitioner on whose professional service the incident-to service is based. The physician does not need to be physically in the room with the ancillary provider, but he or she must be available in the immediate office suite. 2. Incident-to billing excludes inpatient hospital billing. Many hospital outpatient services need the presence and monitoring of a physician and contain incident-to language. Physicians must be in the same building when incident-to services are given by qualified providers, so physicians may need to sign in and out of a log book to document when they are on and off site. 3. Third-party payers may or may not recognize incident-to billing, and each insurance carrier has its own policies about it.

1. Benefit paid by Medicare for a service provided by an employee who is a nurse, physician’s assistant, anesthetist, psychologist, technician, occupational therapist, or physical therapist. A physician bills Medicare for the service. When the services provided are integral, though incidental, to the physician’s professional service and are performed under direct supervision of the physician, Medicare classifies this care as “incident to a physician’s professional services” (e.g., a diabetic patient who reports to a clinic for checkups. 2. In the hospital setting, this term is used for revenue codes for pharmacy, supplies, and anesthesia with radiological procedures and other diagnostic services.

To cut body tissue (e.g., wound or cavity) and remove fluid or infected material.

Phrase used in ICD-9-CM numeric code system to identify conditions that are included for coding diagnoses.

Phrase used in ICD-9-CM numeric code system that identifies lists of conditions that are similar and may be coded or classified by the same medical code.