Author: Glossary

Hospital jargon referring to a patient for whom a code blue signal has been sent, indicating the occurrence of a cardiac (heart) emergency. Similarly, when a do not resuscitate order (DNR) has been recorded for a patient, that patient, in hospital jargon, is “not to be coded” (resuscitated).  

A group of physicians practicing together, either all of one specialty (single specialty) or with various specialties (multispecialty). Such a clinic may or may not have inpatient facilities.  

An instructional session, such as a prenatal clinic where expectant mothers are instructed in their own care and prepared for the care of their babies. In medical education, a clinic is where students are taught by demonstration with actual patients.  

A facility for ambulatory patients.  

One of the primary federal antitrust laws. The Clayton Act specifically prohibits price discrimination (selling to different buyers at different, discriminatory prices) (Section 2(a), as amended by the Robinson-Patman Act), tying arrangements, exclusive dealing, and corporate expansion if these activities substantially lessen competition or create a monopoly. It also prohibits interlocking corporate directorships where the…

The procedure by which claims for payment for services are reviewed in order to determine whether they should be paid, and for what amount. The review includes verifying that an authorized provider is submitting the claim, that the person served is a beneficiary, that the services are medically reasonable and are for available benefits, and…

A service offered by private entrepreneurs to Medicare beneficiaries and others with health insurance. The service offers to “file, follow-up, and manage” claims (see claim). Often the service charges a “registration” fee plus monthly fees. Such a service, which costs perhaps $100 per beneficiary per year, adds to the cost of health care by that…

An allegation of legal liability and an accompanying demand for damages (money) or other rights due. The term is sometimes used in health care to refer to a medical malpractice lawsuit, or to an allegation of malpractice (which allegation may or may not result in a lawsuit).  

A request for payment of insurance benefits to be paid to or on behalf of a beneficiary.  

A fine. “Civil” pertains to legal matters which are not criminal, but “penalty” means that the money to be paid is for punishment of the wrongdoer, rather than as compensation to the injured.