Category: R

Services which must be offered by a health program in order to meet some external standard. Under title XIX of the Social Security Act, each State must offer certain basic health services before it can qualify as having a Medicaid program (and thus for eligibility for Federal matching funds). The required services are: hospital services;…

A coded listing of physician or other professional services using units which indicate the relative value of the various services they perform: taking into account the time, skill and overhead cost required for each service; but not usually considering the relative cost-effectiveness of the services, the relative need or demand for them, or their importance…

The practice of one insurance company buying insurance from a second company for the purpose of protecting itself against part or all of the losses it might incur in the process of honoring the claims of its policyholders. The original company is called the ceding company; the second is the assuming company or reinsurer. Reinsurance…

A tax which takes a decreasing proportion of income as income rises, such as sales taxes and the social security payroll tax on earnings above the maximum to which the tax applies. This tax is a constant percentage of income up to the maximum level (wage base), or a proportional tax up to that level.…

A list of individuals who have given explicit indication (for instance by contracting for membership) that they use or rely upon a given health professional or program (whose registry it is; for the services that the professional or program is able to provide. Panel is sometimes used in preference to registry with respect to individual…

A program of Federal support for regional organizations, called regional medical programs, which seek in their regions to improve the care for heart disease, cancer, strokes and related diseases. The legislative authority, created, is found in title IX of the PHS Act. The programs were heavily oriented towards initiating and improving continuing education, nursing services,…

In licensure of health manpower, the recognition by one State of the licenses of a second State when the latter State extends the same recognition to licenses of the former State. Licensing requirements in the two States must usually be equivalent before formal or informal reciprocal agreements are made. Reciprocity is often used interchangeably with…

Generally the amount which a third party using cost-related reimbursement will actually reimburse. Under Medicare reasonable costs are costs actually incurred in delivering health services excluding any part of such incurred costs found to be unnecessary for the efficient delivery of needed health services. The law stipulates that, except for certain deductible and coinsurance amounts…

For any specific service covered under Medicare, the lower of the customary charge by a particular physician for that service and the prevailing charge by physicians in the geographic area for that service. Reimbursement is based on the lower of the reasonable and actual charges. For example, suppose the prevailing charge for a fistulectomy is…

In insurance, the process of determining rates, or the cost of insurance, for individuals, groups or classes of risks. The determination, by an actuary, of the health care risk (actuarial) for a given group in order to establish the insurance premium to be charged.