Mindblown: a blog about philosophy.
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Reasonable charge
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…
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Rating
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.
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Radiologic technologist or technician
An individual who maintains and safely uses equipment and supplies necessary to demonstrate portions of the human body on X-ray film or fluoroscopic screen for diagnostic purposes, and may supervise and/or teach other radiologic personnel. An estimated 100,000 persons were employed either full-time or part-time as radiologic technologists in 1973: approximately one-third by hospitals, while…
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Quotes
In Congress, material in a law which amends another, earlier Act of Congress is placed in quotes, and material which does not (new, free-standing legislative authority) is not. Thus material amending another law (such as the Public Health Service Act) is said to be ‘in the quotes’.
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Quality assurance program for medical care in the hospital
A program developed by the American Hospital Association for use by hospital administrations and medical staff’s in the development of a hospital program to assure the quality of the care given in the hospital.
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Qualification
Meeting standards for program eligibility licensure, reimbursement or other benefits. Thus a qualified educational program meets accreditation standards, a qualified HMO (for the benefit of mandated dual-choice under section 1310 of the PHS Act) meets the standards imposed by the HMO Act, and a qualified provider for reimbursement by an insurance program meets its conditions…
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Public health service act
One of the principal Acts of Congress providing legislative authority for Federal health activities. Originally enacted July 1, 1944 (and sometimes referred to as the Act of July 1), the PHS Act was, when enacted, a complete codification of all the accumulated Federal public health laws. Since that time many of the Acts written in…
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Public health
The science dealing with the protection and improvement of community health, by organized community effort. Public health activities are generally those which are less amenable to being undertaken or less effective when undertaken on an individual basis, and do not typically include direct personal health services. Immunizations, sanitation, preventive medicine, quarantine and other disease control…
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Psychosomatic illness
Disease that shows a physical dysfunction or lesion in which psychological and other non-physical factors play a causative role, e.g. asthma, vasomotor rhinitis, peptic ulcer, colonic disorders, arterial hypertension, chronic urticaria, coronary’ disease and hyperthyroidism. These should be distinguished from mental disorders and from the psychic effects of diseases which are not psychically caused. A…
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Prudent buyer principle
The principle that Medicare should not reimburse a provider for a cost that is not a reasonable cost because it is in excess of the amount that a prudent and cost-conscious buyer would be expected to pay. For example, an organization that does not seek the customary discount on bulk purchases could, through the operation…
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