carve-out

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carve-out

(karv-owt),
That portion of a provider bill denied for payment (for example, by an insurer). The term may be modified by a time period (for example, day c.), for a Sunday when no diagnostic or specific therapeutic activities were undertaken for a hospitalized patient.

carve-out

adjective Referring or pertaining to:
(1) A program that excludes certain services—usually from an organisation’s capitated rate—and tends to focus on one disease in depth;
(2) An arrangement in which some benefits (e.g., mental health) are removed from coverage provided by an insurance plan, but are provided through a contract with a separate set of providers;
(3) A population subgroup for whom separate healthcare arrangements are made.

carve-out

Managed care adjective Referring to
1. A program that excludes certain services—usually from an organization's capitated rate—and tends to focus on one disease in depth.
2. An arrangement in which some benefits–eg mental health are removed from coverage provided by an insurance plan, but are provided through a contract with a separate set of providers.
3. A population subgroup for whom separate health care arrangements are made.

carve-out

(kahrv'owt)
Portion of a health care provider's charges denied for payment (e.g., by an insurer).
References in periodicals archive ?
Conemaugh Health is also using the data stored in Phynance to model the financial implications of carve outs, alternate fee schedules and modifier rules during future negotiations with payers.
Few, if any, contractors are willing to take the full risk of such contracts, and so carefully orchestrated exclusions or "carve outs" open the doors widely to costly "extras" change orders that add five, ten or at times 25 percent to the cost of the original contract.
In addition, 63% expected to achieve monetization through transactions like the sale of subsidiaries (63%) or carve outs (22%).