reimbursement: gatekeeping
The process by which a primary care physician directly provides the primary patient care and coordinates all diagnostic testing and specialty referrals required for a patient's medical care. To receive referrals to specialists and hospitals, the care must be prior-authorized by the "gatekeeper" unless there is an emergency. Gatekeeping is a subset of the functions of the primary physician case manager.*
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*Extracted from Family Physicians and Managed Care: A View to the 90's: (paperback 1993) with permission from American Academy of Family Physicians