Dictionary of Health Insurance and Managed Care.pdf

DICTIONARY OF

HEALTH INSURANCE

AND

MANAGED CARE

David Edward Marcinko

MBA, CFP © , CMP ©

Editor-in-Chief

Hope Rachel Hetico

RN, MSHA, CPHQ, CMP ©

Managing Editor

NEW YORK

No part of this publication may be reproduced, stored in a retrieval system, or transmitted

in any form or by any means, electronic, mechanical, photocopying, recording, or

otherwise, without the prior permission of Springer Publishing Company, Inc.

Springer Publishing Company, Inc.

11 West 42nd Street

New York, NY 10036

Acquisitions Editor: Sheri W. Sussman

Production Editor: Sara Yoo

Cover design by Mimi Flow

Typeset by Compset, Inc.

06 07 08 09 10/ 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Dictionary of health insurance and managed care/David Edward Marcinko,

editor-in-chief.

p. ; cm.

Includes bibliographical references.

ISBN 0–8261–4994–4

1. Insurance, Health—Dictionaries. 2. Managed care plans (Medical care)

—Dictionaries. I. Marcinko, David E. (David Edward)

[DNLM: 1. Insurance, Health—Terminology—English. 2. Managed Care

Programs—Terminology—English. W 15 D554 2006]

RA413.D53 2006

368.38´2003—dc22

2005029976

Printed in the United States of America by Banta Book Group.

Contents

Biographies .............................................................................................. v

Preface .................................................................................................... vii

Foreword ................................................................................................. ix

Acknowledgments .................................................................................. xi

Instructions for Use ............................................................................... xii

Terminology: A-Z ..................................................................................... 1

Acronyms and Abbreviations ............................................................. 301

Bibliography ........................................................................................ 355

iii

Dr. David Edward Marcinko, MBA, CFP © , CMP © , is a health

care economist and former board-certi ed surgical fellow

from Temple University in Philadelphia. In the past, he edited

four practice-management books, three medical texts in two

languages, six nancial planning books, and two CD-ROMs

for physicians, nancial advisors, accountants, attorneys,

and business consultants. Internationally recognized for his

work, he provides litigation support and expert witness testimony in state and

federal court, with clinical publications archived in the Library of Congress

and the Library of Medicine at the National Institute of Health. His thought

leadership essays have been cited in many scholarly journals (e.g., Physicians

Practice, Managed Care Executives, Medical Interface, Plastic Surgery Products,

Teaching and Learning in Medicine, Orthodontics Today, Podiatry Management,

the Journal of the American Medical Association [JAMA.ama-assn.org], and

Physician’s Money Digest ); by professional organizations (e.g., the Medical

Group Management Association [MGMA], American College of Emergency

Physicians [ACEP], American College of Medical Practice Executives

[ACMPE], and American College of Physician Executives [ACPE]; and by

academic institutions (e.g., the Northern University College of Business,

UCLA School of Medicine, Medical College of Wisconsin, Southern Illinois

College of Medicine, Washington University School of Medicine, University of

Pennsylvania Medical and Dental Libraries, University of North Texas Health

Science Center, Emory University School of Medicine, and the Goizueta School

of Business at Emory University). Dr. Marcinko also has numerous editorial

and reviewing roles to his credit. His most recent textbook from Springer

Publishing Company is e Advanced Business of Medical Practice . A favorite

on the lecture circuit and a linguistic docent o en quoted in the media, he

speaks frequently to medical and nancial services societies throughout the

country in an entertaining and witty fashion.

Dr. Marcinko received his undergraduate degree from Loyola College

(Baltimore), completed his internship and residency training at Atlanta

Hospital and Medical Center, earned his business degree from the Keller

Graduate School of Management (Chicago), and his nancial planning

diploma from Oglethorpe University (Atlanta). He is a licensee of the

Certi ed Financial Planner © Board of Standards (Denver) and holds the

Certi ed Medical Planner © designation (CMP © ). He obtained Series #7

(general securities), Series #63 (uniform securities state law), and Series #65

(investment advisory) licenses from the National Association of Securities

Dealers (NASD) and a life, health, disability, variable annuity, and property-

casualty license from the State of Georgia. Dr. Marcinko was also a cofounder

of an ambulatory surgery center that was sold to a publicly traded company,

a Certi ed Professional in Health Care Quality (CPHQ), a medical-sta vice

president of a general hospital, an assistant residency director, a founder

of a computer-based testing rm for doctors, and a president of a regional

physician practice-management corporation in the Midwest.

Currently, Dr. Marcinko is chief executive o cer and provost for the Institute

o ces in ve states and Europe, and works with a diverse list of individual

charter designation program. As a national educational resource center

its network of independent professionals provide nancial solutions and

managerial peace of mind to physicians, emerging health care organizations,

and their consulting advisors.

her nursing degree from Valpariso University, and master’s

degree in Health Care Administration from the University of

St. Francis, in Joliette, Illinois. She is operations editor of a dozen

textbooks and a nationally known expert in managed medical

care, medical reimbursement, case management, infection

control, health insurance and risk management, utilization

review, National Committee on Quality Assurance (NCQA), Health Plan and

Employer Data and Information Set (HEDIS), and Joint Commission on the

Accreditation of Healthcare Organizations (JCAHO) rules and regulations.

With a well-documented history of identifying innovations in education and

accelerating their adoption by the medical, insurance, and nancial services

industries, she is frequently quoted in the health care business media and

brings a decade of entrepreneurship and creative leadership skills to the

chief operating o cer, she was a senior hospital executive, nancial advisor,

licensed insurance agent, Medicare, Medigap and long-term-care specialist,

certi ed professional in health care quality (CPHQ), and distinguished visiting

instructor in health care administration for the University of Phoenix, Graduate

School of Business and Management, in Atlanta. Ms. Hetico was also regional

corporate director for medical quality improvement at Abbey Healthcare, a

public company in Costa Mesa, California. Now, she is responsible for leading

www.MedicalBusinessAdvisors.com to the top of the exploding business-to-

business educational marketplace, while continuing to nurture the company’s

rapidly expanding list of medical and nancial services clients and colleagues.

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