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It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The US Health Maintenance Organization Act of 1973 required employers with 25 or more employees ...
Consumer Assessment of Healthcare Providers and Systems (CAHPS) refers to a set of surveys that ask patients to report on their health care experiences. [1] The surveys are free to anyone who wants to use them. They focus on aspects of healthcare quality that patients find important and are well-equipped to assess, such as the communication ...
Titles There are five sections to the act, known as titles. Title I: Health Care Access, Portability, and Renewability Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code. Furthermore, Title I addresses ...
The Healthcare Effectiveness Data and Information Set ( HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
The chief complaint, formally known as CC in the medical field, or termed presenting complaint ( PC) in Europe and Canada, forms the second step of medical history taking. It is sometimes also referred to as reason for encounter ( RFE ), presenting problem, problem on admission or reason for presenting. [citation needed] [1] The chief complaint ...
Medical and health care providers experienced 767 security breaches resulting in the compromised confidential health information of 23,625,933 patients during the period of 2006–2012. [78] One major issue that has risen on the privacy of the US network for electronic health records is the strategy to secure the privacy of patients .
Clinical peer review. Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [1] [2] A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review ).
4 common commercial insurance claims. Familiarity with the most common business insurance claims can be helpful if you ever need to file a claim on your own. Some of the most common include: 1 ...