Gatekeeper in Medical Billing
A gatekeeper is typically the primary care provider (PCP) responsible for coordinating a patient’s care and approving referrals to specialists.
Gatekeeper in Medical Billing Explained
In medical billing, the gatekeeper ensures that patients receive appropriate care by managing access to specialists and services. Many insurance plans, especially HMOs, require patients to get a referral from their gatekeeper before seeing a specialist.
For example, a patient must get approval from their PCP, acting as the gatekeeper, to visit an orthopedic surgeon.
See common acronyms and abbreviations in Medical billing glossary.
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