Glossary Flashcards
Accreditation
Self-assessment and external peer assessment process used by healthcare organizations to accurately assess performance level in relation to established standards and to implement ways to continuously improve.
Acute Care
Medical attention given to patients with sudden onset conditions demanding urgent attention/care of limited duration when patient’s health/wellness would deteriorate without treatment.
Acute Inpatient Care
Level of healthcare delivered to patients experiencing acute illness or trauma. Generally short term (less than 30 days).
Advance Beneficiary Notice (ABN)
Written notice issued to fee-for-service (original Medicare) beneficiary before furnishing items/services usually covered by Medicare but expected not to be in a specific instance for reasons such as lack of medical necessity.
Advance Directive
Legal document in which person outlines what they would like to be done if no longer able to make decisions for themselves due to incapacity or illness. Also called medical directive, healthcare directive, living will.
Ambulatory Services
Surgical treatment followed by discharge within 4-6 hours. Can occur in outpatient hospital department or in freestanding ambulatory care facility. Also called Same-Day Surgery.
Ancillary Services
Scheduled/non-scheduled services such as radiology, laboratory, and/or other services performed in hospital or clinic setting, to which patients are referred by provider. Patients leave facility once services completed.
Anti-Kickback Statute
Anti-fraud federal criminal statute prohibiting offers or exchange of anything of value for healthcare business referrals, including cash, rent, expensive hotel stays, etc.
Authorization Requirement
Applies to some services (for which some insurers may require CPT code), not to others.
Batch Processing
Execution of series of jobs in computer program without manual intervention, used to help maximize computer resource use and stabilize response time by performing system-intensive work during hours when users are less likely to require access. Jobs are not available to view until after batch is run.
Carve Out
Separate purchase of services/devices typically under HMO plan. (Ex.: specialized vendor selected to supply behavioral health benefits.) Pre-certification/pre-authorization often required.
Case Management
Coordination of services to help meet patient’s healthcare needs.
Centers for Medicare and Medicaid Services (CMS)
Federal agency under Department of Health and Human Services (HHS) that adminsters Medicare, partners with state governments for administration of Medicaid/other programs (e.g., CHIP).
CHAMPVA
Civilian Health and Medical Program for the Veterans’ Administration - insurance program for families of veterans.
Charity Care
Free/discounted medical care provided to patients without ability to pay for all/part of medical costs due to limited income/financial hardship.
Co-insurance
Percentage amount payable toward medical costs after deductible is met.
Condition Code 44
Patient’s admission status changed from inpatient to observation after internal review determines services do not meet inpatient criteria.
Co-payment
Payment that must be made by covered person at time of service. Services requiring co-pay (such as physician visits, prescriptions, hospital services) specified in policy.
Electronic Protected Health Information (ePHI)
Protected Health Information (PHI) identified under HIPAA that is produced, saved, received, or transferred in electronic format.
Deductible
Amount of eligible expenses person must pay each year before plan will begin to pay for eligible benefits.
DNV-GL Accreditation
DNV Healthcare, approved by CMS in 2008, is an accreditation organization that has accredited approximately 500 hospitals.
Downtime
Time the computer system is unavailable to users.
Electronic Health Record (EHR)
Real-time, digitized version of medical history allowing secure information access to authorized users. Can contain shared information from multiple providers to develop comprehensive patient history.
Emergency Medical Treatment and Labor Act (EMTALA)
Federal law protecting patients against discrimination regardless of ability to pay and mandating patients receive medical screening/stabilizing treatment when seeking emergency care or actively in labor, before payment can be taken. Also called “Anti-Dumping” statute.
