Frequently repeated process of an insurance company that constitutes a customary procedure.

One of three components used in the formula to develop relative value units (RVUs) for each medical service performed. PE consists of salaries, fringe benefits, and purchase and use of medical equipment and supplies. The other two components are (1) amount of physician work and (2) the cost of professional liability insurance. These three RVUs are then adjusted according to geographical area and used in a formula to determine the resource-based relative value scale (RBRVS) for the Medicare fees published annually in the Federal Register.

Suggested procedures and policies for patient management to help physicians in decisions about quality health care for certain medical conditions. Some managed care plans and professional organizations have guidelines to evaluate appropriateness and medical necessity of services such as the American Medical Association. Also called critical pathways, practice options, practice parameters, practice policies, practice standards, or treatment protocols.

Individual qualified to practice in a specialized professional field (e.g., family practitioner or nurse practitioner).

Component of a managed care plan that reviews an inpatient hospital stay prospectively to determine coverage. Also called preauthorization. See precertification.