Bonus Pool
Extra money provided to physicians who spend less on his/her assigned patients' health needs than a preset target.
Managed Care Glossary
Capitation
The practice of paying a fixed sum per assigned patient per month to a physician who is expected to provide all required care for that patient.
Gatekeeper
see P.C.P.
Nurse Practioner
A trained nurse who evaluates and treats patients.
In Network
See P.P.O.
Out of Network
See P.P.O.
P.C.P.
Primary Care Physician
The physician responsible for coordinating all of the care of his/her assigned patients. This physician typically receives a capitated payment and is subject to withholds for exceeding projected expenses.
The physician responsible for coordinating all of the care of his/her assigned patients. This physician typically receives a capitated payment and is subject to withholds for exceeding projected expenses.
Physician Assistant
A trained person used to evaluate and treat patients.
P.O.S.
Point of Service Option
An insurance plan option utilized by some HMOs to allow patients to see physicians outside of the HMO for an increased cost.
An insurance plan option utilized by some HMOs to allow patients to see physicians outside of the HMO for an increased cost.
Withhold
Money withheld by an insurance company from a physician's fee to cover exceeding preset cost targets.
Withholds can be for several different targets and may be based upon pharmacy costs, laboratory or xray testing, emergency room visits, hospitalizations, surgeries, or consultations to name just a few.
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