Financial account balances of patients’ records that remain uncoded after the bill-hold period expires or claims that have not passed the edits and have not yet been corrected.

In managed care plans, this is a form used when a patient presents for services without a referral to a specialist. It may also be used when a patient accesses services of a primary care provider (PCP) who is not the patient’s designated PCP or is not in the PCP’s call share group. The patient is asked to sign this form to indicate an understanding that he or she may be financially responsible for charges incurred during the visit.

Access, release, transfer, or otherwise divulge health information to any internal or external user of the data.

Under the Health Insurance Portability and Accountability Act (HIPAA), a log that lists the individuals and companies that have received personal health information (PHI) for use that is unrelated to treatment and payment. Items to be documented must include date of disclosure, name of entity that received the PHI, brief description of the PHI disclosed, and brief statement of the purpose of the disclosure.

1. Reduction of a normal charge based on a specific amount of money or a percentage of the charge. 2. In a managed care plan’s contract with a provider, the discount is the percentage deducted during settlement of the claim from the allowed amount.
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Discount is a reduction in premium in respect of some favorable features of the risk, e.g., discount for Fire extinguishing appliances or for freedom from claims, and where customary, as in marine Insurance, originating from a reward for prompt payment of premium.

Record of certain drugs and their proper dosages that shows the drugs the pharmaceutical company will sell at a reduced cost.

Type of fee-for-service payment in which a managed care plan negotiates a discounted fee with a provider that is less than the usual or customary fee. It may be a fixed amount per service or a percentage discount. Physicians may be attracted to such negotiations because they represent a way to increase the volume of patients seen or reduce the chance of losing volume. Also called contracted discount rate .

Formal statement that a managed care plan sends to a physician or hospital facility that indicates an inconsistency between their data about the disposition of a patient such as group number or difference in claim amount.

Outlays of funds subject to the federal appropriations process.

Coordinated program that follows specific diseases or conditions and their treatments and introduces treatment to get the best outcome, prevent recurrence, and reduce the cost of care. Such programs exist for individuals who have asthma, diabetes, depression, and lipid disorders. Pharmaceutical companies work with physicians who maintain databases of drugs used to treat these diseases and conditions. Sometimes called disease state management, outcomes management, population-based care, population-based care management , or care mapping .