P

Patient-centered Care

Model for care delivery that accounts for the needs and preferences of patients and their families.

Patient Protection and Affordable Care Act (PPACA)

The 2010 health care reform law, also referred to as the Affordable Care Act, the ACA, and Obamacare.

Payer

The organization or individual responsible for paying the costs of a health care procedure.

Pay for Performance

A health care payment method, which offers incentives to providers in exchange for meeting or exceeding the quality and cost benchmarks. Systems also punish providers for not meeting benchmarks in order to encourage the improvement of quality.

Payment Bundling

A mechanism of provider payment where providers or hospitals receive a single payment for all of the care provided for an episode of illness, rather than per service. Total care provided for an episode of illness may include both acute and post-acute care.

Payment Error Rate Measurement (PERM)

The measure of the improper payments of Medicaid and CHIP, which results in an error rate for each program. These rates are based on multiple factors; fee-for-service (FFS), managed care and eligibility sections of Medicaid and CHIP in the fiscal year under review.

Pay or Play

Colloquial term for an ACA provision requiring employers to offer health insurance or pay a fine.

Pended Claim

An insurance term for claims that are missing information necessary for the insurer to make a coverage decision.

Percent of Poverty

A term for the income of an individual as it relates to the federal poverty line; it is often used to determine if an individual qualifies for a government program.

Per Member Per Month (PMPM)

A payment plan, which gives a provider organization a specific amount of money to be spent on various services for patients enrolled in programs for a specific period of time.

Managed Care

A health delivery system that aims to limit health care costs and improve the quality of care by controlling access to the use of health…