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Ambulatory
care
Health services delivered on an outpatient basis. A patient's
treatment at a doctor's office or a surgical center without
an overnight stay is considered ambulatory care; home
treatment is not. |
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Authorization
The approval of care, such as hospitalization. Preauthorization
may be required before a patient is admitted or given
care by a non-HMO provider. |
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Cafeteria
plan
A flexible benefits plan that generally offers a choice
of two or more qualified benefits or the option of cash.
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Capitation
A per-member monthly payment to a provider that covers
contracted services and is actuarially determined on the
basis of costs expected to be incurred. This is an alternative
to the fee-for-service arrangement. |
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Case
management
a form of utilization review used with high-cost cases
in which a health care professional monitors and manages
treatment and suggests alternatives to lengthy hospital
stays. The case manager supervises the administration
of medical or ancillary services to a patient, typically
one who has a catastrophic disorder or is receiving mental
health services.
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