Contractor hired to investigate an allegation of fraud and establish a case after it is substantiated. Also called contractor. Also see potential fraud case (PSC).

Written notation, dated and signed, by a member of the health care team, that summarizes the facts about the medical care given and the patient’s response during a specific period of time. Also called chart note.

Written or dictated letter or chart note documenting details about subsequent examinations of the patient.

System of giving medically necessary health care at any given stage in illness or recovery (i.e., from acute care in a hospital through the recuperation phase).

A temporary or permanent increase in severity of impairment of a body part, organ, or system. This may be due to disease or injury (e.g., hearing loss going from bad to worse).

System in which an insurance plan employs new rates either monthly, quarterly, or semiannually. Individuals who apply or renew policies are affected by the rates in effect.

Supervises and administers the implementation of a data system that can support personal health records and website content.

Appointed person who is responsible overall for a project. A departmental person is usually appointed.

Potential insurance claim costs that are expected for a specific group over a time period.

Degree of variation between estimated and actual amounts.