| F |
| Federally-Qualified
HMO |
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An
HMO that meets certain federally stipulated
provisions aimed at protecting consumers: e.g.,
providing a broad range of basic health
services, assuring financial solvency, and
monitoring the quality of care. HMOs must apply
to the federal government for qualification. The
Office of Prepaid Health Care of the Health Care
Financing Administration (HCFA), Department of
Health and Human Services (DHHS) administer the
process. |
| Fee |
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A
charge or price for professional services. |
| Fee
Disclosure |
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Physicians
and caregivers discussing their charges with
patients prior to treatment. |
| Fee-For-Service |
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(a)
A method of reimbursement based on payment for
services rendered. An insurance company, the
patient or a government program such as Medicare
or Medicaid may make payment.
(b) With respect to the physicians or other
supplier of service, this refers to payment in
specific amounts for specific services
rendered--as opposed to retainer, salary, or
other contract arrangements. In relation to the
patient, it refers to payment in specific
amounts for specific services received, in
contrast to the advance payment of an insurance
premium or membership fee for coverage, through
which the services or payment to the supplier
are provided. |
| Fee
Schedule |
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A
listing of accepted fees or established
allowances for specified medical procedures. As
used in medical care plans, it usually
represents the maximum amounts the program will
pay for the specified procedures. |
| First-dollar
coverage |
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Insurance
coverage with no front-end deductible where
coverage begins with the first dollar of expense
incurred by the insured for any covered benefit. |
| Fiscal
Intermediary |
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The
agent (e.g., Blue Cross) that has contracted
with providers of service to process claims for
reimbursement under health care coverage. In
addition to handling financial matters, it may
perform other functions such as providing
consultative services or serving as a center for
communication with providers and making audits
of providers' needs. |
| Fixed
Costs |
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Costs
which do not change with fluctuations in census
or in utilization of services. |
| Flat
Fee-Per-Case |
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Flat
fee paid for a client's treatment based on their
diagnosis and/or presenting problem. For this
fee, the provider covers all of the services the
client requires for a specific period of time.
Often characterizes "second
generation" managed care systems. After the
MCOs squeeze out costs by discounting fees, they
often come to this method. If provider is still
standing after discount blitz, this approach can
be good for provider and clients, since it
permits a lot of flexibility for provider in
meeting client needs. |
| Formulary |
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A
list of selected pharmaceuticals and their
appropriate dosages felt to be the most useful
and cost effective for patient care.
Organizations often develop a formulary under
the aegis of a pharmacy and therapeutics
committee. In HMOs, physicians are often
required to prescribe from the formulary. |
