term Flashcards
Activity Limitation
Difficulties an individual may have in executing activities.
Range from slight to severe in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition.
Actual Value
Real Value. Measures the worth one derives from using or consuming a good, product, service or an item, and represents the utility of the good, product, service, or item
Actuarial Study
Statistical analysis of a population based on its utilization of healthcare services and demographic trends of the population. Results used to estimate healthcare plan premiums or costs
ACTUARY
Trained insurance professional.
Specializes in determining policy rates, calculating premiums, and conducting statistical studies
ACUITY
Complexity and severity of the clients health/medical condition
ACUTE CARE
Treats sudden and acute episodes of illness.
Medical, surgical, emergency.
setting include hospitals, acute rehab, emergency care, transitional hospitals, follow up long term disease management settings.
ADA
Americans with Disabilities Act of 1990
ADA AMENDMENTS ACT
(ADAAA)
Americans with Disabilities Act Amendments Act of 2008
ADAPTIVE BEHAVIOR
Effectiveness and degree to which an individual meets standards of self sufficiency and social responsibility for his age related cultural group
ADHERENCE
The extent to which a persons behavior corresponds with agreed recommendations from a health care provider.
taking meds, diet, lifestyle changes
ADHESIVE CONTRACT
A contract between two parties.
the party with stronger bargaining power sets the terms and conditions.
the weaker party, with no ability to negotiate, must adhere to the contract, and is placed in a Take it or leave it position.
ADJUSTED CLINICAL GROUP®
(ACG) SYSTEM
Developed by the School of Public Health at Johns Hopkins. This system clusters clients into homogenous groups based on a unique approach to measuring morbidity to ultimately improve Accuracy and fairness in evaluating
healthcare provider performance
Identifying clients at high risk
Forecasting healthcare utilization
Setting equitable payment structure & rates for the providers.
ADJUSTER
A person who handles claims.
Also called Claims Service Rep
ADMINISTRATIVE LAW
Branch of public law.
Deals with various organizations of federal, state and local governments.
Prescribes in detail the manner of their activities.
ADMINISTRATIVE SERVICES ONLY
(ASO)
An insurance company or third party administrator.
Delivers administrative services to an employer group.
This usually requires the employer to be at risk for the cost of healthcare services provided,
which the ASO processes and manages claims
