Quick Reference: Key Terms

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10 Terms

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DRG

fixed payment per classification

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Capitation

set monthly fee per enrollee

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Deductible

out-of-pocket cost before insurance pays

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Gatekeeping

PCP controls access to specialists

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Retrospective Review

post-service utilization review

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Fee-for-Service

payment per unit of service

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COBRA

continuation of employer health coverage

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Vertical Integration

linked services for continuity of care

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Critical Access Hospital

25 or less acute care beds

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National Health Expenditures

total annual health spending