Resource-based Relative Value Scale – The list of services and RVUs from which Medicare physician payment is determined; services are assigned a relative value that is adjusted by a geographic price cost index (GPCI) and multiplied by a conversion factor.
Further reading –
https://www.ama-assn.org/rbrvs-overview
Relative Value Units – One element in the formula used to calculate the Medicare allowance for a given service in a specific fee schedule area; each Medicare physician fee schedule service is assigned RVUs for physician work, for practice expenses and malpractice expenses.
Further reading –
https://en.wikipedia.org/wiki/Relative_value_unit
Regional Extension Center – One of as many as 70 organizations defined by a specific geographic area, funded through the Health Information Technology for Economic and Clinical Health (HITECH) Act, and charged with helping physicians choose, implement and achieve meaningful use of electronic health records.
Further reading –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925411/
Regional Health Information Organization – A multi-stakeholder organization created to facilitate the electronic transfer of health information across organizations and communities.
Further reading –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995627/
Independent Practice Association – An independent group of physicians who legally organize as an entity and agree to contract as a group to provide patient services; the practices maintain their own offices and continue to see their own patients.
Further reading –
http://www.aafp.org/about/policies/all/independent-physicianassoc.html
International Classification of Diseases, 9th Revision, Clinical Modification – A standardized system currently used in the United States that classifies diseases, injuries and external causes by etiology and anatomic location and assigns each entry an identifier that may be up to five alpha-numeric characters in length.
Further reading –
https://www.cdc.gov/nchs/icd/icd9cm.htm
Accountable Care Organization – A network of health care professionals and organizations that band together to provide health care services for a defined population of patients; the network is paid to provide coordinated comprehensive care to patients and assumes responsibility for the cost and quality of that care.
Further reading –
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
The Qualified Disabled Working Individual (QDWI) program is a state-administered program that pays Medicare Part A (hospital insurance) premiums for disabled people who have gone back to work. There are certain basic requirements you must meet to be eligible. You must:
be under the age of 65
be disabled
be ineligible for free Medicare Part A because your disability benefits were ceased due to working above the SGA limit
be ineligible for state medical assistance (Medicaid), and
meet the income and asset tests in your state.
QDWI pays your premiums for Part A, but it does not pay the Part A deductible or copayments or anything toward Part B. (If your income is very low (under 135% FPL) despite working, you could qualify for a Medicare Savings Program that pays some of these expenses.)
Further reading –
https://www.benefits.gov/benefits/benefit-details/6180
The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits .
Further reading –
https://www.medicaid.gov/medicaid/ltss/pace/index.html
Outpatient Prospective Payment System – In response to rapidly growing Medicare expenditures for outpatient services and large co-payments being made by Medicare beneficiaries, Congress mandated that the Centers for Medicare and Medicaid Services (CMS) develop a Hospital Outpatient Prospective Payment System (HOPPS) and reduce beneficiary co-payments.
Further reading
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988668/
