Assigned weight calculated by the Centers for Medicare and Medicaid Services (CMS) that reflects the resource consumption of each diagnosis-related group (DRG). The higher the relative weight, the larger the payment to the facility. Relative weights are published in the final prospective payment system rule.

Measure used in health care cost accounting and data analysis that links the amount of personnel time, medical resources, and cost to care for a diagnosis-related group (DRG). If the RWP is higher, then more hospital resources are needed to care for that disease or injury. Also called ambulatory weighted unit .

Monetary dollar amount that indicates the average work of a physician of average efficiency relative to a given standard.

Person who files a qui tam suit on behalf of the U.S. government. See qui tam action, qui tam provision, and whistleblower .

To disclose a patient’s protected health information (PHI). See authorization form and consent form for mandates required by the Health Insurance Portability and Accountability Act (HIPAA).

Data that include truthful written or oral allegations or other material facts that might cause a noninterested third party to think there is reason to believe a specific set of data exists (e.g., false claims submitted for noncovered or miscoded services).

Document detailing services billed and describing payment determination (paid or denied) for one or more beneficiaries issued to providers of managed care or federal programs (Medicare or Medicaid) for a specific payment period; formerly known as Explanation of Medicare Benefits (EOMB) . Sometimes a payment check is attached to the form. Also known in some programs as an explanation of benefits, remittance notice, or standard paper remittance (SPR) .

Document that accompanies all Medi-Cal payment vouchers (checks) sent to providers of medical services.

Act of paying or compensating for medical services given to a patient.
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UK: Total payments from the employer for the year assessable as income under Schedule E but excluding anything arising from the acquisition/disposal of shares or interest in shares. In regard to Class A members any pay in excess of the earnings cap will be disregarded in assessing allowable contributions to approved pension schemes.

Hospital unit that is approved to furnish transplantation and other medical and surgical specialty services directly for the care of end-stage renal disease (ESRD) transplant patients including inpatient dialysis furnished directly or under arrangement.