In workers’ compensation cases, employment of fewer than 30 hours per week for one employer.

Managed care capitation contract that concerns a capitated payment plus a payment for the actual cost of providing care and medical services to enrollees. This combination of capitation and fee-for-service reimbursement is sometimes a method for developing toward the total capitation of providers in a medical group or market area.

MEDICAL,USA: 1. Disability from an illness (congenital or acquired) or injury that prevents an insured person from performing one or more of the functions of his or her regular job. Loss of function may be expressed as a percentage. 2. Individual who has permanently lost a specific percentage of earning capacity.
***
An illness or injury which prevents an insured person from performing one or more of his occupational duties.
***
Reduction in ability to do things and work that one could when in full health. The degree of disability will vary with the severity of the injury or illness. A provision generally found in accident and occasionally in sickness policies designed to offer some weekly or monthly indemnity benefit if the insured cannot perform all the important daily duties of his occupation.
***
US: The result of an illness or injury which prevents an insured from performing one or more of the functions of his/her regular job. A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation.

Dollar amount stated in a disability income insurance policy that is paid when the insured has a partial disability (prevented from doing one or more of his or her daily job duties). See residual disability benefit.

Structured therapeutic program that is less than 24-hour care (usually during the day) in a hospital facility or other institution (mental or substance abuse facility, rehabilitation hospital, intermediate care facility) for patients moving from full-time inpatient care to outpatient care. Cardiac and chronic pain patients could also use this service.

Program in which a patient attends for several hours during the day (e.g., 8:30 am to 3:30 pm) . The patient is not there on a 24-hour basis. When completing the CMS-1500 for billing this type of case, the place of service code 52 is inserted in Block 24B of the paper claim form.

Incomplete reimbursement by a third-party payer to the provider or patient for medical services listed on a patient’s insurance claim.
***
(01) Any claim for less than the full sum insured. (02) Partial claim settlement paid on account, before a claim is finalized or closed.

Process of ending a pension or employee-benefit plan for a group of participants but not for another group. Sometimes this is done so that sponsors can reclaim some of the assets of an overfunded plan.

Procedure that is a part of a larger surgical procedure and needs a separate code (e.g., partial cystectomy vs. complete cystectomy). See separate procedure to learn the difference between partial and separate procedure. See also complete procedure to learn the difference between partial versus complete.