Program developed by the Department of Veterans Affairs (VA) to allow the VA to bill third-party payers for non-service-connected care rendered by the VA to veterans and to collect copayments from veterans with less than a 50% service-connected disability rating for non-service-connected care given, based on ability to pay.

1. Form of health care review in which a component of the quality assurance program audits and monitors the quality of both the delivery and organization of medical services. The purpose is to ensure that health care services are appropriate to the patients’ needs and of the highest quality and that the managed care plan in place supports and provides the care. 2. The Medicare Conditions of Participation require an audit with the use of screening criteria for evaluation by diagnosis and/or procedure. Utilization review requirements under Medicare and Medicaid require utilization review committees in hospitals and skilled nursing facilities to have at least one such study in progress at all times. Such studies are required by the Quality Improvement Organization (QIO) program. This is called medical care evaluation studies (MCE studies) .

Codes that characterize a medical condition or treatment. These code sets are usually maintained by professional societies and public health organizations. Compare with administrative code sets.

Health care management process done after performing a history and physical examination on a patient that results in a plan of treatment. It is based on establishing one or more diagnoses and/or selecting a management or treatment option, amount of data or complexity of data reviewed, and complications and/or morbidity or mortality. Four types of MDM are straightforward, low complexity (LC), moderate complexity (MC), and high complexity (HC).

Defined by Medicare, an anesthesiologist’s involvement with a certified registered nurse anesthetist (CRNA) or anesthesiology assistant (AA) in one, two, three, or four concurrent procedures where the anesthesiologist is physically present and where all the seven requirements are met and documented. Medicare does not recognize medical direction by the anesthesiologist if he or she is involved in more than four concurrent procedures. When the anesthesiologist takes on five or more cases, he or she is supervising or has failed to meet the medical direction requirements, with a few exceptions [Medicare Carriers Manual, Section 4830].

Usually a physician who is employed by a hospital or managed care organization (MCO) in an administrative capacity as head of the organized medical staff. He or she acts as a liaison for the staff with the administration and governing body.

Individual who reviews onscreen notes or a computer-generated hard copy document while listening to the physician’s voice on tape. The correctionist makes changes related to voice recognition errors such as corrections, changes, additions, and deletions. The final product is given to the physician for review before becoming part of the patient’s medical record. Also referred to as a correctionist . See also medical proofreader .