Introduction To Healthcare Pricing
Expert-defined terms from the Certificato Professionale per la Creazione di una Strategia di Prezzi Sanitari (Italia) course at Greenwich School of Business and Finance. Free to read, free to share, paired with a professional course.
Acceptable Use Policy refers to a set of rules and guidelines that outline the a… #
Related terms include compliance, regulatory requirements, and ethics. Acceptable use policies are essential in healthcare pricing as they ensure that resources are utilized efficiently and effectively, while also maintaining the integrity of the healthcare system.
Access Pricing refers to the process of determining the optimal pr… #
Related terms include price elasticity, demand analysis, and revenue management. Access pricing is critical in healthcare as it directly impacts patient access to essential services and quality of care.
Accountable Care Organization (ACO) refers to a network of healthcare<… #
Related terms include value-based care, population health, and care coordination. ACOs play a crucial role in healthcare pricing as they aim to reduce costs and improve quality of care through collaborative efforts.
Activity #
Based Costing (ABC) refers to a methodology used to assign costs to specific activities or services within a healthcare organization, allowing for more accurate cost accounting and pricing. Related terms include cost allocation, resource utilization, and financial management. ABC is essential in healthcare pricing as it enables precise cost calculation and informed decision-making.
Add #
On Pricing refers to a strategy where a base price is set for a healthcare service or product, and then additional fees are charged for optional or ancillary services. Related terms include price bundling, unbundling, and revenue enhancement. Add-on pricing is commonly used in healthcare to increase revenue and profit margins.
Administrative Cost refers to the expenses incurred by a healthcare</i… #
Related terms include overhead costs, operational expenses, and financial management. Administrative costs are a significant component of healthcare pricing, as they impact the bottom line and reimbursement rates.
Alternative Payment Model (APM) refers to a payment approach that deviate… #
Related terms include payment reform, value-based care, and population health. APMs are increasingly used in healthcare to promote high-quality and cost-effective care.
Ambulatory Care refers to healthcare services provided on an outpatien… #
Related terms include outpatient services, primary care, and specialty care. Ambulatory care is a significant component of healthcare pricing, as it accounts for a large portion of healthcare expenditures.
Average Wholesale Price (AWP) refers to the average price at which a p… #
Related terms include manufacturer pricing, retail pricing, and reimbursement rates. AWP is used as a benchmark for pharmaceutical pricing and reimbursement in healthcare.
Bundled Payment refers to a payment approach where a single payment</b… #
Related terms include episode-based payment, value-based care, and care coordination. Bundled payments are used in healthcare to promote efficient and cost-effective care.
Capitation refers to a payment approach where a fixed amount is pa… #
Related terms include risk-based payment, value-based care, and population health. Capitation is used in healthcare to promote preventive care and population health management.
Case Mix refers to the mix of patients or cases treated by… #
Related terms include diagnosis-related groups, severity adjustment, and reimbursement rates. Case mix is essential in healthcare pricing, as it impacts reimbursement rates and resource allocation.
Chargemaster refers to a comprehensive list of charges for heal… #
Related terms include price list, fee schedule, and revenue cycle management. The chargemaster is a critical component of healthcare pricing, as it determines the prices charged to patients and payers.
Claim refers to a request for payment or reimbursement subm… #
Related terms include billing, coding, and reimbursement. Claims are a critical component of healthcare pricing, as they impact revenue cycle management and cash flow.
Clinical Decision Support (CDS) refers to technology or tools used… #
Related terms include electronic health records, artificial intelligence, and care coordination. CDS is essential in healthcare pricing, as it impacts quality of care and resource utilization.
Cost Accounting refers to the process of assigning costs to specif… #
Related terms include activity-based costing, financial management, and budgeting. Cost accounting is essential in healthcare pricing, as it enables informed decision-making and resource allocation.
Cost #
Benefit Analysis (CBA) refers to a methodology used to evaluate the costs and benefits of a project or initiative, allowing for more informed decision-making. Related terms include cost-effectiveness analysis, return on investment, and financial management. CBA is essential in healthcare pricing, as it impacts investment decisions and resource allocation.
Cost #
Effectiveness Analysis (CEA) refers to a methodology used to evaluate the costs and effectiveness of a project or initiative, allowing for more informed decision-making. Related terms include cost-benefit analysis, return on investment, and financial management. CEA is essential in healthcare pricing, as it impacts investment decisions and resource allocation.
Cost #
Sharing refers to the practice of dividing costs between patients and payers or insurers, such as copayments, coinsurance, and deductibles. Related terms include out-of-pocket costs, cost containment, and affordability. Cost-sharing is a critical component of healthcare pricing, as it impacts patient access to care and financial burden.
Current Procedural Terminology (CPT) refers to a standardized system of <… #
Related terms include International Classification of Diseases, Healthcare Common Procedure Coding System, and coding guidelines. CPT is essential in healthcare pricing, as it determines the prices charged for services rendered.
Data Analytics refers to the process of analyzing data to extract… #
Related terms include business intelligence, predictive analytics, and data mining. Data analytics is essential in healthcare pricing, as it impacts revenue cycle management, cost containment, and quality improvement.
Diagnosis #
Related Group (DRG) refers to a system of codes used to classify hospital cases into groups based on diagnosis, procedure, and resource utilization, allowing for more accurate reimbursement. Related terms include case mix, severity adjustment, and reimbursement rates. DRGs are essential in healthcare pricing, as they determine the prices paid for inpatient services.
Dual Eligibles refer to individuals who are eligible for both Medicare… #
Related terms include Medicare Advantage, Medicaid expansion, and dual special needs plans. Dual eligibles are a critical component of healthcare pricing, as they impact reimbursement rates and care coordination.
Electronic Health Record (EHR) refers to a digital version of a patien… #
Related terms include health information exchange, interoperability, and clinical decision support. EHRs are essential in healthcare pricing, as they impact quality of care, resource utilization, and reimbursement rates.
Evidence #
Based Medicine (EBM) refers to a approach to medical decision-making that emphasizes the use of scientific evidence and research to guide clinical practice. Related terms include clinical guidelines, quality measures, and outcomes research. EBM is essential in healthcare pricing, as it impacts quality of care, resource utilization, and reimbursement rates.
Fee #
For-Service (FFS) refers to a payment model where providers are paid for each service or procedure performed, rather than for a package of care or outcomes. Related terms include volume-based payment, fee schedule, and reimbursement rates. FFS is a common payment model in healthcare, but it can create incentives for overutilization and inefficient care.
Financial Management refers to the process of managing financial r… #
Related terms include cost accounting, financial planning, and strategic management. Financial management is essential in healthcare pricing, as it impacts reimbursement rates, cash flow, and financial sustainability.
Global Payment refers to a payment model where a single payment is… #
Related terms include capitation, value-based care, and population health. Global payment is used in healthcare to promote efficient and cost-effective care.
Health Information Exchange (HIE) refers to the electronic sharing of … #
Related terms include electronic health records, interoperability, and clinical decision support. HIE is essential in healthcare pricing, as it impacts quality of care, resource utilization, and reimbursement rates.
Health Maintenance Organization (HMO) refers to a type of health p… #
Related terms include preferred provider organization, point of service plan, and health insurance. HMOs are a common type of health plan, and they can impact reimbursement rates and care coordination.
Healthcare Effectiveness Data and Information Set (HEDIS) refers to a set … #
Related terms include quality measures, performance metrics, and accountability. HEDIS is essential in healthcare pricing, as it impacts quality of care, resource utilization, and reimbursement rates.
International Classification of Diseases (ICD) refers to a standardized s… #
Related terms include Current Procedural Terminology, Healthcare Common Procedure Coding System, and coding guidelines. ICD is essential in healthcare pricing, as it determines the prices charged for services rendered.
Managed Care refers to a type of health care delivery system that… #
Related terms include health maintenance organization, preferred provider organization, and point of service plan. Managed care is a common type of health care delivery system, and it can impact reimbursement rates and care coordination.
Medicaid refers to a government program that provides health insur… #
Related terms include Medicare, Children's Health Insurance Program, and health reform. Medicaid is a critical component of healthcare pricing, as it impacts reimbursement rates and care coordination.
Medicare refers to a government program that provides health insur… #
Related terms include Medicaid, Medicare Advantage, and health reform. Medicare is a critical component of healthcare pricing, as it impacts reimbursement rates and care coordination.
Medicare Advantage refers to a type of Medicare plan that provides… #
Related terms include Medicare, Medicaid, and health reform. Medicare Advantage is a common type of Medicare plan, and it can impact reimbursement rates and care coordination.
Network refers to a group of providers or health plans that… #
Related terms include preferred provider organization, health maintenance organization, and point of service plan. Networks are a common feature of healthcare pricing, as they impact reimbursement rates and care coordination.
Out #
of-Network refers to services provided by providers who are not part of a patient's health plan network. Related terms include in-network, out-of-pocket costs, and balance billing. Out-of-network care can impact reimbursement rates and financial burden on patients.
Out #
of-Pocket refers to costs that are paid directly by patients for healthcare services, such as copayments, coinsurance, and deductibles. Related terms include cost-sharing, cost containment, and affordability. Out-of-pocket costs are a critical component of healthcare pricing, as they impact patient access to care and financial burden.
Outcomes #
Based Payment refers to a payment model where providers are paid based on the outcomes of care, rather than the volume or intensity of services provided. Related terms include value-based care, pay-for-performance, and quality measures. Outcomes-based payment is used in healthcare to promote high-quality and cost-effective care.
Pay #
for-Performance (P4P) refers to a payment model where providers are paid based on their performance on quality measures, rather than the volume or intensity of services provided. Related terms include value-based care, outcomes-based payment, and quality measures. P4P is used in healthcare to promote high-quality and cost-effective care.
Payment Reform refers to efforts to change the way healthcare serv… #
Related terms include healthcare reform, affordable care act, and quality improvement. Payment reform is essential in healthcare pricing, as it impacts reimbursement rates, care coordination, and quality of care.
Pharmaceutical Pricing refers to the process of determining the price<… #
Related terms include price negotiation, rebates, and reimbursement rates. Pharmaceutical pricing is a critical component of healthcare pricing, as it impacts patient access to care and financial burden.
Preferred Provider Organization (PPO) refers to a type of health p… #
Related terms include health maintenance organization, point of service plan, and health insurance. PPOs are a common type of health plan, and they can impact reimbursement rates and care coordination.
Price Transparency refers to the practice of making prices for … #
Related terms include price disclosure, cost estimation, and consumer protection. Price transparency is essential in healthcare pricing, as it impacts patient decision-making and financial planning.
Quality Measures refer to standards or metrics used to evaluate th… #
Related terms include pay-for-performance, value-based care, and outcomes-based payment. Quality measures are essential in healthcare pricing, as they impact reimbursement rates, care coordination, and quality of care.
Reimbursement refers to the process of paying providers for hea… #
Related terms include payment reform, value-based care, and quality measures. Reimbursement is a critical component of healthcare pricing, as it impacts provider revenue, care coordination, and quality of care.
Resource #
Based Relative Value Scale (RBRVS) refers to a system used to determine the value of medical services, taking into account resource utilization, complexity, and time required. Related terms include fee schedule, payment reform, and reimbursement rates. RBRVS is essential in healthcare pricing, as it determines the prices paid for services rendered.
Revenue Cycle Management refers to the process of managing the financi… #
Revenue cycle management is essential in healthcare pricing, as it impacts cash flow, financial sustainability, and quality of care.
Risk Adjustment refers to the process of adjusting payment rates o… #
Risk adjustment is essential in healthcare pricing, as it impacts reimbursement rates and financial sustainability.
Severity Adjustment refers to the process of adjusting payment rat… #
Related terms include case mix, risk adjustment, and reimbursement rates. Severity adjustment is essential in healthcare pricing, as it impacts reimbursement rates and financial sustainability.
Value #
Based Care refers to a payment model where providers are paid based on the value of care provided, rather than the volume or intensity of services provided. Related terms include pay-for-performance, outcomes-based payment, and quality measures. Value-based care is essential in healthcare pricing, as it promotes high-quality and cost-effective care.
Value #
Based Payment refers to a payment model where providers are paid based on the value of care provided, rather than the volume or intensity of services provided. Value-based payment is essential in healthcare pricing, as it promotes high-quality and cost-effective care.
Volume #
Based Payment refers to a payment model where providers are paid based on the volume of services provided, rather than the value or outcomes of care. Related terms include fee-for-service, payment reform, and quality measures. Volume-based payment is a common payment model in healthcare, but it can create incentives for overutilization and inefficient care.