Federal commission that was replaced by the Medicare Payment Advisory Commission (MedPAC). See Medicare Payment Advisory Commission (MedPAC or MedPac).

Method of payment mandated by the Balanced Budget Act of 1997 (BBA) that changed Medicare hospital payments from cost based to prospective, based on national average capital costs per case. Examples of PPS include Medicare’s physician fee schedule and for inpatient diagnosis-related groups (DRGs) that set a predetermined, fixed dollar amount for a principal diagnosis. PPS helps Medicare control its spending by encouraging providers to furnish care that is efficient, appropriate, and typical of practice expenses for providers. Patients and resource needs are statistically grouped, and the system is adjusted for patient characteristics that affect the cost of providing care. A unit of service is then established, with a fixed, predetermined amount for payment. Sometimes called prospective reimbursement. Also see outpatient prospective payment system (OPPS).

To set a price before rendering a service (e.g., the Medicare prospective payment system [PPS]). The opposite of this would be the reimbursement system in which the medical service is given first and then the provider of the service receives payment.

MEDICAL,USA: 1. To find out a future property or liability insurance rate. 2. Premium for a certain projected period of time based on the loss experience of a specific prior period of time. In such a contract, the carrier assumes the risk (inadequate or excessive) and the purchaser pays a fixed rate for the contract period. Other factors may be considered in adjusting the rates for renewal of insurance such as insurance industry trends or inflation.
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A method used in arriving at the rate and premium for a specified future period, based in whole or in part on the loss experience of a prior specified period.
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A way of calculating the rates or premiums for a particular period in the future. This method is based on the losses sustained during a particular period in the past.
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REINSURANCE,REFERENCE: See: Rating

1. Process of going over financial documents before billing is submitted to the insurance company to determine documentation deficiencies and errors. 2. Method of evaluating a case before admission to find out if hospitalization is necessary, the estimated length of stay, or alternate outpatient treatment.

Procedure or test for the early detection of prostate cancer (e.g., digital rectal examination, prostate specific antigen [PSA] blood test).

Blood test, detects marker for adenocarcinoma of the prostate.

Design, construction, attachment, and use of artificial limbs or other substitutes to function for missing body parts.

Under the Health Insurance Portability and Accountability Act (HIPAA), any data held by a covered entity or its business associate that identifies an individual and describes his or her health status, age, sex, ethnicity, or other demographical characteristics, whether or not that information is stored or transmitted electronically (see Box P-1 ). Additionally, PHI may include physician-patient interactions and conversations, physician-staff conversations, internal physician-physician conversations, external physician-physician conversations, staff-family communications, staff-staff conversations, physician dictation, and telephones in examination rooms. Sometimes erroneously referred to as private health information or personal health information.Box P-1Protected Health Information in a Medical OfficeIntake formsLaboratory work requestsPhysician-patient conversationsConversations that refer to patients by namePhysician dictation tapesTelephone conversations with patientsEncounter sheetsPhysician’s notesPrescriptionsInsurance claim formsX-raysE-mail messages