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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
A hospital information system (HIS) is an element of health informatics that focuses mainly on the administrational needs of hospitals.In many implementations, a HIS is a comprehensive, integrated information system designed to manage all the aspects of a hospital's operation, such as medical, administrative, financial, and legal issues and the corresponding processing of services.
Healthcare quality and safety require that the right information be available at the right time to support patient care and health system management decisions. Gaining consensus on essential data content and documentation standards is a necessary prerequisite for high-quality data in the interconnected healthcare system of the future.
Although it is widely recognized and applied in many health care related fields, the Donabedian Model was developed to assess quality of care in clinical practice. [7] The model does not have an implicit definition of quality care so that it can be applied to problems of broad or narrow scope. [ 6 ]
Poor monitoring and control, the fee-for-service payment system, insurance companies' limited role, insufficient monitoring of insurance companies, the educational nature of our health centers, health-care providers' interests, and the information gap that exists between patients and providers were all significant factors in the induced demand ...
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. [1] This bill is called a claim. [2]
Revenue cycle management (RCM) is the process used by healthcare systems in the United States and all over the world to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. It is a normal part of health administration. The revenue cycle can be defined as, "all ...
Essential for the implementation of the integrated care program is a framework that guides the process. In Ireland, the Health Service Executive (HSE) is implementing an integrated care program according to a 10-Step Framework. [13] This Framework is created along the recommendation of the World Health Organization. [14] [15]