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A coding scheme also helps WBS elements to be recognized in any written context, such as progress tracking, scheduling, or billing, and allows for mapping to the WBS Dictionary. [ citation needed ] It is a preferred practice that the Statement of work or other contract descriptive include the same section terms and hierarchical structure as the ...
Providers may bear all of the savings and/or excess costs (100% risk), or they may bear a fraction of the risk while payers continue to bear the rest. Exclusions, tail risk, and stop-loss criteria: Bundled payment models may choose to set up a variety of safeguards that limit the financial risk that providers bear under extreme circumstances.
Electronic referral, when a specialist evaluates medical data (such as laboratory tests or photos) to diagnose a patient instead of seeing the patient in person, would often improve health care quality and lower costs. However, "in the private fee-for-service context, the loss of specialist income is a powerful barrier to e-referral, a barrier ...
Since the subjective probability of the presence of a condition is never exactly 100% or 0%, the differential diagnostic procedure may aim at specifying these various probabilities to form indications for further action. The following are two methods of differential diagnosis, being based on epidemiology and likelihood ratios, respectively.
Fee-for-service is a traditional kind of health care policy: insurance companies pay medical staff fees for each service provided to an insured patient. Such plans offer a wide choice of doctors and hospitals. Fee-for-service coverage falls into Basic and Major Medical Protection categories.
The Coding Accuracy Support System (CASS) enables the United States Postal Service (USPS) to evaluate the accuracy of software that corrects and matches street addresses.CASS certification is offered to all mailers, service bureaus, and software vendors that would like the USPS to evaluate the quality of their address-matching software and improve the accuracy of their ZIP+4, carrier route ...
The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate the total body surface area (BSA) affected by a burn. In addition to determining burn severity, the measurement of burn surface area is important for estimating patients' fluid requirements and determining hospital admission criteria.
Insurance companies themselves, as well as self-insuring employers, purchase stop-loss coverage for a premium to protect themselves. [1] In the case of a participant reaching more than the specific (or "individual") stop-loss deductible ($300,000, for example), the insurer will reimburse the insured (the company, not the participant) for the remainder of the claim to be paid over that ...