Podiatry > Identification of High-Severity Patients
Podiatry claims are reviewed monthly to determine if a member is, or has become, a high-severity patient. A high-severity patient is one for whom, during the time period of a valid contact point, a singular procedure was performed, among others, and such single service equals or exceeds 11.72 relative value units (RVUs) as defined by Medicare and geographically adjusted to New York City.
Glossary terms found on this page:
An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.
A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.
An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.