Category: R

A person who is involved with working out the terms and details of reimbursement systems with third-party payers. Sometimes just refers to a person who prepares the statements and other materials needed to obtain reimbursement from third-party payers and insurers for services, and who maintains the related records.  

The payment to a hospital or other provider, after the fact, of an amount equal to the provider’s expenses in providing a given service or product. The current trend is away from such a “blank check” approach and toward prospective pricing, that is, toward agreement in advance as to the amount which will be paid…

Realistic goals for the individual patient with respect to (1) management of the patient’s specific health problems and (2) achievement of self-care, independence, and emotional well-being. These goals are set and stated by the attending physician for each patient at the time of admission to a rehabilitation hospital or long-term care facility (LTCF).  

A central agency where data from an institution or specific geographic area can be collected and made available for study and, in the health care field, sometimes made available for assisting in patient care management. An illustration of the latter use is in sending reminders to patients when follow-up examinations are scheduled (for example, in…

A rural hospital classified as such by the federal government, for purposes of reimbursement under the Medicare prospective payment system (PPS).  

A nonprofit public-policy organization in San Francisco, one of whose goals is to develop a new measure of the economic condition of the nation.  

To reject or challenge an individual’s qualification to serve in a given capacity, usually on the basis of conflict of interest or known bias. Usually used with respect to a judge or juror. Individuals may also recuse themselves voluntarily, to avoid the appearance of impropriety.  

Determining and certifying as to the competency of a physician or other professional at some time after the initial determination of his or her qualification for licensure or hospital privileges. Recredentialing is required at periodic intervals in some hospitals and health care organizations. It is also under consideration by several states as a procedure to…

The process of formally continuing the medical staff membership of a physician or other health care professional, along with specific privileges. After the initial appointment to the staff, reappointment must take place at regular intervals (usually every year or two). During the reappointment process, the performance of the professional is evaluated, so that a proper…

A process of withholding goods or services when they are in short supply. Rationing of health care is, of course, in one sense in effect, since it is not possible to provide all the care which has been proven effective to all the individuals who might benefit from it. In the climate of health care…