Glossary of Terms in Health Care
The following are definitions of commonly used terms in the medical provider, hospitaland Insurance Companies.
When used as a legal term in healthcare, it normally refers to actions that do not involveintentional misrepresentations in billing but which, nevertheless, result in improper conduct. Consequences can result in civil liability and administrative sanctions. Anexample of abuse is the excessive use of medical supplies. (also see Fraud, OIG, FBI,Compliance)
The patient's ability to obtain medical care. The ease of access is determined by suchcomponents as the availability of medical services and their acceptability to the patient,the location of health care facilities, transportation, hours of operation and cost of care.An individual's ability to obtain appropriate health care services. Barriers to access can befinancial (insufficient monetary resources), geographic (distance to providers),organizational (lack of available providers) and sociological (e.g., discrimination,language barriers). Efforts to improve access often focus on providing/improving healthcoverage.
Accountable Health Plan (AHP)
AHPs can be IDSs, MCOs, Health Networks, partnerships or joint ventures between practitioners, providers or payers that would assume responsibility for delivering medicalcare and managing the funds required to pay for the services rendered. Physicians andother providers would either work for, contract with or own these health plans. When anIDS or hospital group or IPA operates one or more health insurance benefit products, or amanaged care organization acquires a large scale medical delivery component, it qualifiesas an Accountable Health System or Accountable Health Plan.
Accountable Health Partnership
An organization of doctors and hospitals which provides care for people organized intolarge groups of purchasers.
The process by which an organization recognizes a program of study or an institution asmeeting predetermined standards. Two organizations that accredit managed care plans are