Glossary of Healthcare Terms and Abbreviations

OF
HEALTHCARE TERMS & ABBREVIATIONS
JULY 2002
OF
H EALTHCARE T ERMS & A BBREVIATIONS
All rights reserved. No part of this publication may be reproduced in any form without the prior written permission of the publisher, the New Jersey Hospital Association (NJHA). NJHA is not responsible for any misprints, typographical or other errors, or any consequences caused as a result of the use of this publication. This publication is provided with the understanding that NJHA is not engaged in rendering any legal, accounting or other professional services and NJHA shall not be held liable for any circumstances arising out of its use. If legal advice or other expert assistance is required, the services of a competent professional should be sought.
JULY 2002
PREFACE
ospitals rely greatly on the talents and expertise of groups of individuals who donate their time to the hospital. These individuals, serving as hospital trustee, auxiliary leader, or other volunteer, while usually not professionally educated in the field of healthcare, are often called on to discuss healthcare issues. The Glossary of Healthcare Terms and Abbreviations, a project of the NJHA Council on Hospital Governance, is designed to help these individuals understand the everyday language of healthcare. This Glossary, while primarily intended to familiarize members of hospital governance boards with the language of healthcare, will be of value to anyone involved in healthcare. It serves as a quick read of commonly used healthcare terms and abbreviations. The NJHA Council on Hospital Governance encourages reference to the Glossary as a way to better understand the meaning of todays most pressing healthcare issues.
Gary S. Carter, FACHE President and CEO New Jersey Hospital Association
Glossary of Healthcare Terms & Abbreviations
CONTENTS
TS
Introduction ............................................................................................ iii
Glossary of Healthcare Terms.................................................................. 1
Frequently Used Abbreviations/Acronyms ............................................ 31
II
INTRODUCTION
he language of healthcare has changed drastically over the past two decades. The NJHA Council on Governances first glossary, for example, was called Glossary of HOSPITAL Terms and Abbreviations. Now, titled the Glossary of HEALTHCARE Terms and Abbreviations, it reflects hospitals movement beyond their own four walls. At one time, the language of healthcare was almost exclusively within the medical domain. Now, one must also be fluent in the language of business, finance and computer technology. The Glossary is designed as an easy-to-use reference. Users of the Glossary will find words and terms dealing with medicine, finance, insurance and the computer world. It is not an allinclusive healthcare dictionary, but rather a glossary of words, terms and abbreviations commonly used by professionals involved in New Jerseys hospital and healthcare industry. The first section of the Glossary includes definitions of words and terms, defined within the context of the healthcare world. Any commonly used abbreviations or acronyms for the words and terms are provided. A list of frequently used general healthcare abbreviations and or acronyms comprise the second section. Future revisions of the Glossary will be published as needed. It is through such revisions that the Council on Hospital Governance will continue to help non-healthcare professionals participate in meaningful healthcare dialogue. The Council on Hospital Governance gratefully acknowledges the expertise and assistance of NJHA staff in the development of the original and revised edition of the Glossary.
III
Glossary of Healthcare Terms

APD Access Accounts Receivable Accreditation
Adjusted patient day. An accounting method for modifying the definition of inpatient days to include outpatient revenues. Potential and actual entry of a population into the healthcare delivery system. Assets arising from services provided or the sales of goods to patients on credit A process of evaluating an institution to see if it meets standards set by the accrediting body. Generally refers to the evaluation by the Joint Commission on Accreditation of Health Care Organizations. (see JCAHO) A JCAHO publication published annually, consisting of policies and procedures relating to hospital accreditation surveys, hospital standards and scoring guidelines used to determine levels of compliance with the standards. (see JCAHO) Basic self-care activities, including eating, bathing, dressing, transferring from bed to chair, bowel and bladder control and independent ambulation. ADLs are widely used as a measure of evaluating independent functional status. Generally refers to inpatient hospital care of a short duration as opposed to ambulatory care or long-term care for the chronically ill. A program that provides a combination of health, recreational and social services to older adults during the day. Services may include comprehensive assessment, health monitoring, occupational therapy, personal care, a noon meal and transportation. Some programs also provide primary healthcare and rehabilitation services.
Accreditation Manual For Hospitals
Activities Of Daily Living (ADL)
Acute Care
Adult Day Care
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Advanced Directive AIDS
see Living Will Acquired Immune Deficiency Syndrome is an incurable, usually fatal dieseace caused by a virus hat destroys the bodys ability to fight off illness. AIDS causes recurrent infections or secondary diseases affecting multiple body systems. A plan to impose uniform prices of medical services, regardless of who is paying. Professionally educated and certified non-physician healthcare providers, including nurse practitioners, certified registered nurse anesthetists, respiratory therapists, physicians= assistants and others. Refers to alternatives to fee-for-service systems for delivering healthcare. Examples include health maintenance organizations (HMOs), independent practice associations (IPAs) and preferred provider organizations (PPOs). (see HMOs, IPAs, PHOs, PPOs and PSOs) Care delivered on an outpatient basis, including primary care, same- day surgery and outpatient diagnostic services. Services provided to hospital patients in the course of care, other than room, board, medical and nursing services, such as laboratory, radiology, pharmacy and rehabilitation therapy services. An agreement by a physician to bill Medicare or other thirdparty payers directly and accept reasonable charge as full payment for his or her services. If the physician does not accept assignment, the patient is billed for the difference between the Medicare charge and his or her usual charge. Member of a hospital auxiliary who may or may not be an inservice volunteer within the affiliated hospital. The formula used for determining Medicare reimbursement for managed care. The formula is 95 percent of Medicare Part A and B costs per person by county.
All-Payer System Allied Health Professionals
Alternative Delivery
Ambulatory Care Ancillary Services
Assignment
Auxilian Average Adjusted Per Capita Cost (AAPCC)
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Balance Sheet Bed Conversion Bench Marking Biohazard
Statement of assets and liabilities. Allocation of beds from one level of care to another, as in converting acute-care beds to long-term care beds. The process of continually measuring products, services and practices against major competitors or industry leaders. A biological or chemical agent or a condition that is harmful to humans or other living things. A term often used in biohazardous materials like used needles, bandages and other contaminated materials. A term used to describe philosophical questions involving morals, values and ethics in the provision of healthcare. A physician or other health professional who has passed an examination given by a specialty board and has been certified by that board as a specialist in that subject. The practice of charging an all-inclusive package price for all medical services associated with selected procedures. Compact Disc-Read Only Memory; these are discs inscribed with non-erasable data. They are about the same size and appearance as audio compact discs; one disc can hold 300,000 printed pages. Community Health Information Network; also known as a Community Health Management Information System (CHMIS). An electronic information system that transmits healthcare data among hospitals, physicians, employers and third-party payers within a community. The system also contains a data repository for purchasing and quality reports. Computerized axial tomography. An advanced, noninvasive method of radiological diagnosis that creates images of the body in a computerized display. Depreciable property of fixed or permanent nature, such as buildings or equipment, that is not held for sale in the regular course of business.
Biomedical Ethics Board Certified
Bundled Billing CD-ROM
CHIN
CT or CAT Scan
Capital Asset
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Capital Cost
Hospitals costs for major fixed or durable assets, such as plant and property, movable equipment, and working capital. (see depreciation) Methods for obtaining and accumulating funds for capital needs. A method of paying for health services on a per-person basis as opposed to fee-for-services basis. For example, HMOs charge subscribers a fixed fee per person or family for comprehensive coverage. (see alternative delivery systems, HMOs, IPAs, PPOs) Maximum allowable limits placed on revenue or rates by the federal or state government. Typically a captive is a wholly owned subsidiary of a group of hospitals that Companies have organized to insure their risk. A captive is like a self-insurance company program that has assumed the formalities of an insurance company. A minimally invasive procedure used to diagnose disorders of the heart, lungs and great vessels. Services not included in a health plan, but available from another supplier or agent at a different, usually higher, fee. A system of assessment, treatment planning, referral and follow-up that ensures the provision of services, according to client needs, and the coordination of payment and reimbursement for care. A case manager acts as a client advocate, monitoring the individuals progress through the system. A measure of patient acuity reflecting different patients needs for hospital resources. There are many ways of measuring case mix; some are based on patients diagnoses or the severity of their illnesses, and some on their utilization of services. A high case mix index refers to a patient population more ill than average..
Capital Formation Capitation
Caps Captive Insurance
Cardiac Catheterization Carve-Out Case Management
Case Mix
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Computerized Axial Tomography (CAT) Catastrophic Illness
Diagnostic equipment that produces a cross section image of the body. Any acute or prolonged illness that is usually considered to be life-threatening or with the threat of serious residual disability and that entails large expense over an extended period. Geographic area defined and served by a hospital and delineated on the basis of such factors as population distribution, natural geographic boundaries or transportation accessibility. Average number of inpatients, excluding newborn, receiving care each day during a reported period. Formerly known as HCFA (Health Care Financing Administration) this is the governmental department that administrates Medicaid, Medicare and State Childrens Health Insurance Program (SCHIP). A certificate issued by the N.J. Department of Health and Senior Services, to a hospital seeking permission to modify its facility, acquire major medical equipment or offer a new or different health service. The amount billed by a hospital for services provided. A charge generally includes the cost plus an operating margin. Many payers pay a discounted rate, negotiated rate or government-set rate (e.g., PPS). Free medical care rendered to individuals who do not have the ability to pay for such care. Methods used on the Internet for groups of like-minded and/or individuals to talk to each other. The elected or appointed leader of the hospital medical staff organization.
Catchment Area
Census Centers for Medicaid and Medicare Services (CMS) Certificate Of Need (CN)
Charges
Charity Care Chat Bulletin Board ListServ Chief Of Staff
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Childrens Health Insurance Plan (CHIP) State Childrens Health Insurance Plan (SCHIP) Claims Made Coverage
A state administered program funded equally by state and federal for dollars that allows states to provide health coverage to uninsured low-income or children not previously eligible for Medicaid. In New Jersey the program is NJ KidCare. A liability policy form that covers claims made against the insured during the policy period irrespective of when the event occurred that caused the claim to be made. Coverage extends to claims-made (reported or filed) during the year the policy is in force or during a previous period in which the policyholder was insured under a claims-made contract, provided the coverage is continuous with the insurer. In a departmentalized hospital, the medical staff organization is subdivided into major divisions such as medicine, surgery, obstetrics-gynecology, pediatrics and family medicine. Each clinical department has a chief or chairman and is responsible for setting and monitoring standards of professional and personal conduct of physicians within those departments. see critical pathway The right to provide medical or surgical care services in the hospital, within well-defined limits, according to an individuals professional license, education, training, experience and current clinical competence. Hospital privileges must be delineated individually for each practitioner by the hospital board, based on medical staff recommendations. As applied to the medical staff as a whole, an arrangement wherein no new applicants are accepted. A codified collection of regulations issued by various departments, bureaus and agencies of the federal government that is promoted in the Federal Register. Requirement of an insurance policy or prepayment plan that the beneficiary pay a predetermined portion or percentage of the providers charges.
Claims-Made Policy
Clinical Department
Clinical Pathway Clinical Privileges
Closed Staff Code of Federal Regulations Co-Insurance
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Commercial Carriers Community Benefits
For-profit, private insurance carriers (i.e. Aetna, Prudential) offering health and other types of coverage. Activities initiated by not-for-profit hospitals to benefit the hospitals community. Community benefits are evolving standards defined by the Internal Revenue Service (IRS) to determine the tax-exempt status of not-for-profit healthcare organizations. Dynamic process undertaken to identify the health, problems and goals of the community, enabling a community-wide establishment of health priorities and facilitating collaborative actionplanning directed toward improving the communitys health status. The community health assessment process involves multiple sectors of the community. A local, community-based ambulatory healthcare program organized and funded by the U.S. Public Health Service that provides primary and preventive health services, often called neighborhood health centers. They are usually located in an area with scarce health services or with a population with special health needs. There are also similar non-federally funded community health programs, sponsored by local hospitals and/or community foundations. A method used to determine a health insurance premium in which a premium is based on the average cost of the actual or anticipated health services used by all subscribers in a specific geographic area or industry. This method spreads the cost of illness evenly over all subscribers rather than charging the sick more than the healthy. A secondary illness. Services that meet the total healthcare needs of a patient.
Community Health Assessment
Community Health Center
Community Rating
Comorbidity Comprehensive Healthcare Congregate Housing
Housing for older adults that includes access to a variety of support services such as laundry or linen service, meal service, a security system, socialization opportunities or transportation. Individual apartments usually include kitchen facilities.
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Consortium
Formal voluntary alliance of institutions, usually from the same geographic area, for a specific purpose, that functions under a set of bylaws. Used by JCAHO to describe its Agenda for Change. The concept at heart of the Total Quality Management philosophy is that quality is never static, but is a constantly moving target, constantly open to improvement. A comprehensive system of long-term care services and support system in the community, as well as in institutions. Continuum includes: 1) community services such as senior centers; 2) in-home care such as home-delivered meals, homemaker services, home health services, shopping assistance, personal care, chore services and friendly visiting; 3) community-based services such as adult day care; 4) non-institutional housing arrangements such as congregate housing, shared housing, and board and care homes; 5) nursing homes; and 6) acute care services. Negotiated discounts from hospital-established charges.
Continuous Quality Improvement
Continuum Of Care
Contractual Allowances Conversion
A major change that a hospital undertakes, such as the conversion from not-for-profit status to for-profit, or the conversion of an acute care facility to ambulatory care. This usually entails a complete change of mission after a new line of business or service displaces a core activity. The formation and use of one or more corporations in addition to the hospital corporation for the purpose of holding assets or carrying out other business activities. Restructuring generally involves either the formation of corporations legally independent of the hospital, or the hospital becoming a subsidiary of a new parent corporate structure. An accounting system arriving at charges by healthcare providers based on actual costs for services rendered.
Corporate Restructuring
Cost Accounting
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Cost Finding
Determining how it much it actually costs to provide a given service. Usually requires a cost accounting system or a retrospective cost study. Having consumers pay a portion of the cost of their healthcare bills or insurance premiums. Increasing the charges to one group of hospital patients to cover or subsidize losses on other groups of patients. The process of checking a practitioners references and documenting his/her credentials, including training and education, experience, demonstrated ability, licensure verification and malpractice insurance. The hospital governing board has ultimate accountability for physician credentialing but usually delegates the process to the medical staff committee. Treatment regimen agreed on by a consensus of clinicians. It includes only those few vital elements proven to affect patient outcomes. Only critical components - items that directly affect care - are part of the critical pathway. Diagnosis-related group(s). A system for classifying hospital patients based on their clinical condition (diagnosis or surgical procedure), age, and whether they had any other illnesses (complications or comorbidities); a predetermined price is set for each of over 500 DRGs. DRGs are the used by the federal government for Medicare prospective pricing system, and until 1993, were the basis for New Jerseys payment system. A variety of indicators displayed visually, much like a cars dashboard. This is key information easy to read to indicate areas of success and those that need improvement. Dashboards often cover clinical quality, revenue, full time employees, patient satisfaction, etc. Amount of loss or expense that the insured must incur before the insurance company will assume any liability for all or part of the remaining cost of covered services.
Cost Sharing Cost Shifting Credentialing
Critical Pathway
DRG(s)
Dashboard
Deductible
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Deemed Status
A hospital is deemed qualified to participate in the Medicare program if it is accredited by the JCAHO, thus obviating the need for a duplicative Medicare accreditation survey. The refusal by a third-party payer to reimburse a provider for services or a refusal to authorize payment for services prospectively. Denials are generally issued on the basis that a hospital admission, diagnostic test, treatment or continued stay is inappropriate according to a set of guidelines. The amortization of the cost of a physical asset (plant, property and equipment) over its useful life. Annual depreciation is the amount charged each year as expense for such assets as building, equipment and vehicles. Accumulated depreciation is the total amount of depreciation of the hospitals financial books. Funded depreciation refers to setting aside and investing the accumulated depreciation so that these monies can be used for replacement and renovation of assets (see capital costs). Protection for directors and officers of corporations against suits or Legal claims brought by stockholders or others alleging that the directors and/or officers acted improperly in some manner in the conduct of their duties. This coverage does not extend to dishonest acts. Discharge planning assists patients and their families in arranging services they will need after discharge from a hospital. Information that may be legally obtained by a party to a lawsuit. In New Jersey there are no laws protecting a hospital from discovery even from a morbidity and mortality meeting or from a sentinel event investigation. A hospital that provides care to a large number of patients who cannot afford to pay or do not have insurance. Reimbursement is at a higher rate under the prospective payment system for inpatient services to cover the higher cost of caring for these patients. Inner city and rural hospitals typically fall into this category.
Denial
Depreciation
Directors and Officers Liability Insurance
Discharge Planning Discoverable
Disproportionate Share Hospital (DSH)
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Do-Not-Resuscitate (DNR)
Order placed on a patients chart by the attending physician, with a patient or surrogate consent that directs hospital personnel not to revive the patient if respiratory or cardiac activity ceases. A listing of prescription medications approved for use by and in a hospital; also used to identify those prescription medications approved for use and/or coverage by health insurance plans. The sale or rental of products and/or equipment designed to assist individuals needing medical care at home. It can include, but is not limited to, wheelchairs, canes, walkers and respirators. Emergency Medical Treatment and Active Labor Act, also known as COBRA Aanti-dumping law. EMTALA requires that all patients who come to the Emergency Department must receive an appropriate medical screening examination regardless of their ability to pay and must be stabilized if they are to be transferred to another facility. Early Periodic Screening, Diagnosis and Treatment Program for children through maternal and child health programs designed to determine illnesses that handicap children. Emergency Medical Systems. Refers to a systematic, community linkage among hospital trauma centers, ambulance emergency units and other emergency vehicles, personnel trained in emergency medicine, and communications systems so that severely ill or injured persons are transported and treated promptly and appropriately. An emergency alarm and response system designed for functionally impaired persons (particularly the elderly) living in the community. The system includes an electronic communication unit that is easily activated (in the home) when there is an emergency, a central emergency station located in a hospital or similar facility that is responsible for receiving incoming alarms, a process of client identification and a quick response team or mechanism.
Drug Formulary
Durable Medical Equipment Services
EMTALA
EPSDT
Emergency Medical System (EMS)
Emergency Response System
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Endowment ERISA
Funds intended to be invested in perpetuity, providing income for the continued support of a not-for-profit organization. Employee Retirement Income Security Act of 1974; selfinsured companies are usually organized under ERISA and are exempt from state laws governing insurance. Hospital Committee concerned with biomedical ethics issues. Its purpose may be to direct educational programs or provide forums for discussion of these issues among hospital medical professionals and others, to serve in an advisory capacity and/or as a resource to healthcare professionals involved in biomedical ethical implications. A healthcare plan in which subscribers are eligible to receive benefits when they use the services of a limited network of providers. Unit for treatment of inpatients who require convalescent, rehabilitative or long-term skilled nursing care. Method of charging patients for services or treatment in which a provider bills for each patient encounter or treatment or service rendered. Detailed report of the financial conditions of an entity including profits, losses, assets and liabilities. Blue Cross Plan, private insurance company, or other public or private agency selected by healthcare providers to pay claims under Medicare. Currently Riverbend in Tennessee is the FI for New Jersey. The section of the tax code that defines nonprofit, charitable, tax-exempt organizations.
Ethics Committee
Exclusive Provider Organization (EPO) Extended Care Unit Fee For Service
Financial Statement Fiscal Intermediary (FI)
501(c)(3)
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Fraud and Abuse
The federal body of law applying to Medicare and Medical providers. This law prohibits three things: filing false claims, paying or receiving bribes or kickbacks for referrals and selfreferral schemes. Violations can result in criminal and/or civil punishment. Enforcement comes under several umbrellas of the government. Civil action in enforced by The Office of the Inspector General (OIG) and Department of Health and Human Services (DHHS). The Department of Justice (DOJ) enforces criminal penalties. Healthcare facilities that are not physically, administratively or financially connected to a hospital. An example is a freestanding ambulatory surgery center. A common description of a compensation agreement between hospitals and physicians. Under the current system of payments for Medicare, this has been deemed illegal by the OIG and DHSS. New Jersey is in discussions with CMS to pilot a program of gainsharing to improve length of stay and other factors to improve Medicare delivery and savings. A term that is generally used to refer to the primary care physician who controls referrals of patients to a hospital or for specialty care. Provides acute care to elderly patients in a separate unit or wing that may include specifically designed units with architectural adaptations designed to accommodate the decreased sensory perception of older adults. Geriatric assessment/rehabilitation units utilize a multidisciplinary team of therapists. Staff are usually trained in geriatrics. An interdisciplinary service providing a comprehensive assessment of the physical and mental health, and the functional, social and financial status of an older adult, resulting in a plan for comprehensive treatment and referral to appropriate providers reflecting individual and family preferences and financial status. An assessment service can be part of an inpatient or ambulatory care setting. (see geriatric acute unit)
Free-Standing Facilities
Gainsharing
Gatekeeper
Geriatric Acute Care Unit
Geriatric Assessment Service
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Geriatric Assessment Team
Disciplinary team of professionals that may have the following members: physicians, nurses, social workers and therapists. The team assesses the medical and psychosocial needs and functional status of elderly patients to determine the services they require. Physician who specializes in the diagnosis and treatment and overall healthcare needs of older adults and is cognizant of the special problems related to aging. The colloquial term used to describe the choice of a provider not to be protected by malpractice or professional liability insurance. Many hospitals prohibit this practice by requiring medical staff members to carry insurance. The legal entity ultimately responsible for hospital policy, organization, management, and quality of care. Also called the governing board, board of trustees, commissioners or directors. The governing body is accountable to the owner(s) of the hospital, which may be a corporation, the community, local government or stockholders. Materials that are harmful to humans and other living things like radioactive, biological or chemical materials or agents. Within a disaster preparedness plan there is often a hazardous material plan incorporated to deal specifically with this type of emergency. In the event of this type of emergency a hospital is required to control patient admissions through a special entrance, decontamination, special equipment for staff, airflow control, etc. A prepaid health plan that acts as both an insurer and a provider of comprehensive health services. HMO subscribers pay a capitated fee and are limited to the hospitals and physicians affiliated with the HMO. (see capitation, IPA, staff model HMO and group model HMO)
Geriatrician
Going Bare
Governing Body
Hazardous materials (HAZMAT)
Health Maintenance Organization (HMO)
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HealthPAC
A political action committee (P.A.C.) formed to educate New Jersey legislators and political candidates regarding issues affecting New Jerseys hospitals. It is an independent, bi-partisan organization, not affiliated with any political party. HealthPAC pools contributions from individuals to financially help support the campaigns of those who demonstrate their commitment to hospitals. Education and/or other supportive services that are hospital planned and coordinated to help people to adopt healthy behaviors, reduce health risks, increase self - care skills, use health care services effectively and increase understanding of medical procedures and therapeutic regimens. A federal program established in the 1960s that created financial assistance for the construction and renovation of hospitals and other healthcare facilities. Named for its two principal congressional proponents, Hill and Burton. Separate entity used to hold a variety of subsidiary groups that often perform related functions but have a distinct corporate identity. A program for providing nursing, therapy and health-related homemaker or social services to individuals in their homes. A document on the Internets World Wide Web (WWW); the home page is usually the first screen presented and contains information and Alinks to the rest of the document (as well as other home pages). The NJHA home page, for example, links the Avisitor to HRET educational programs, NJHA meetings and other important information, as well as to NJHA member hospitals that have their own WWW home page. Programs designed to prevent institutionalization and/or deterioration of an older adult by providing in-home suppor services such as light housekeeping, meal preparation and grocery shopping, as well as personal care services.
Health Promotion Services
Hill-Burton
Holding Company
Home Healthcare Home Page
Homemaker/Home Health Aide
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Horizontal Integration
A linkage or network of the same types of providers i.e., a multi-organizational system composed of acute care hospitals. A competitive strategy used by some hospitals to control the geographical distribution of healthcare services. (see hospital alliance and vertical integration) Care that addresses the physical, spiritual, emotional, psychological, social, financial and legal needs of the person who is terminally ill and his or her family. Hospice care is provided by an interdisciplinary team of professionals and volunteers in a variety of settings, both inpatient and at home and includes bereavement care for the family. A group of not-for-profit hospitals that join together to share common services and pursue business opportunities that could not be supported by the hospitals individually. Typically, the hospitals in an alliance retain their individual autonomy, but may share information and services and do joint planning and group purchasing. A physician who specializes in inpatient medicine. In the hospital setting, the hospitalist functions as a primary care physician does outside of the hospital coordinating care. Aggregate body of physicians and dentists who have completed medical or dental school and who participate in an accredited program of post-graduate medical education sponsored by a hospital. Medical care for those who cannot afford it. (see medically indigent, charity care, uncompensated care) In an IPA, independent doctors and/or small group practices contract with an HMO to provide services to an enrolled population. The physiHMO (IPA) cians may own the HMO and are usually reimbursed on a fee-for-service basis, with a percentage withheld. This Apool of funds held by the IPA=s administration can be redistributed to the doctors in a profitable year.
Hospice Care
Hospital Alliance
Hospitalist
House Staff
Indigent Care Individual Practice Association Model
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Infection, Nosocomial
Infection acquired during hospitalization that is neither present nor incubating at the time of hospital admission, that may become clinically manifest after discharge from the hospital. A patient receiving acute care through admission to the hospital for a stay of longer than 24 hours. Insurance that protects the insured against all or a percentage of loss that is not covered by another insurance or prepayment plan or that is incurred under specified circumstances, or insurance in excess of specified amounts or other dollar or benefit limits. Catastrophic insurance that protects the insured against all or a percentage of loss incurred as the result of severe or prolonged illness or disability in which costs exceed a specified dollar amount. A local or regional healthcare network that provides a full range of System services for all aspects of healthcare in a specific geographic area. Also called community care network. A term used to identify physicians in their first year or two of post- medical school clinical training. They are now more commonly called Post Graduate Year, or PGY I, II, III, IV or V. A facility that provides nursing, supervisory and supportive services to elderly or chronically ill patients who do not require the degree of care or treatment that a skilled nursing unit is designed to provide. A hospital operated by a for-profit corporation in which the profits go to shareholders who own the corporation. Also referred to as a Aproprietary hospital. An independent, voluntary, not-for-profit accreditation body sponsored by the American College of Physicians, the American College of Surgeons, the American Hospital Association, the American Medical Association and the American Dental Association. The JCAHO conducts accreditation surveys for hospitals and other healthcare organizations.
Inpatient Insurance, Catastrophic
Insurance, Major Medical
Integrated Delivery (IDS) Intern
Intermediate Care Facility
Investor-Owned Hospital Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
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Joint Venture
A cooperative financial relationship between two parties (i.e., hospital and physician group, two hospitals, hospital and HMO) in which each party shares risks and benefits. Number of calendar days that elapse between an inpatients admission and discharge. Formal process by which a government agency grants an individual the legal right to practice an occupation; grants an organization the legal right to engage in an activity, such as operation of a hospital; and prohibits all other individuals and organizations from legally doing so, to ensure that the public health, safety and welfare are reasonably well protected. A program through which older adults commit to reside in a community for the remainder of their lives. The community has the physical facilities and services to provide care ranging from freestanding apartments to nursing home care. The concept has insurance features in that an initial payment (entry fee) is required. The fee guarantees residents a specified package of health and long-term care benefits (in addition to Medicare cover services), co-payment and deductibles. Standard developed and updated regularly by the National Fire Protection Association that specifies construction and operational conditions to minimize fire hazards and provide a system of safety in case of fire. A statement of a persons preferences for medical treatment if he or she becomes incapable of making healthcare decisions. Most living wills specify that the person does not want respirators, cardiopulmonary resuscitation or other measures used if there is no hope of recovery. Persons who sign living wills also should make their wishes known to their family and physician. Operation of some living wills is restricted until the patient is terminal. Also known as an Advanced Directive.
Length of Stay (LOS) Licensure
Lifecare/Continuing Care
Life Safety Code
Living Will
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Long-Term Care
Those services designed to provide diagnostic, preventive, therapeutic, rehabilitative, supportive and maintenance services for individuals (and their care givers) who have chronic physical and/or mental impairments; this care is provided in a variety of settings, including the home. The goal of a comprehensive long-term care system is to promote the optimal level of physical, social and psychological functioning. Either free standing or hospitals-within-hospitals, LTACs provide acute care services for patients requiring and average length of stay of at least 25 days. Using a scanner, this is a high-technology diagnostic procedure used to create cross-sectional images of the body through the use of magnetic fields and radio frequency fields. Previously known as nuclear magnetic resonance (NMR). Failure in providing healthcare services to exercise the degree of skill and care generally exercised by like professionals under similar circumstances. Components of the overall cost of health care used to determine the Consumer Price Index (CPI). A systematic process for researching the needs and desires of consumers and customers and designing responsive programs, services and promotional strategies to reach these markets. A program that provides meals on a daily basis (usually Monday through Friday) to homebound older adults who are not able to provide or prepare meals for themselves. A joint federal-state program which since 1966 has paid much of the healthcare costs of certain (but not all) low-income persons. The federal government sets certain minimum rules and payment levels and provides some of the funding, and each state administers the program, contributes additional funds and may establish additional eligibility rules and benefits. Physician who serves as a salaried chief of staff, generally reporting to the CEO, and responsible for medico-administrative affairs.
Long Term Care Acute Care Hospital (LTAC) Magnetic Resonance Imaging (MRI)
Malpractice
Market Basket Marketing
Meals on Wheels
Medicaid
Medical Director
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Medical Education, Director of Medical Savings Account (MSA)
Member of the medical staff of a hospital or an educator who coordinates programs of graduate and continuing medical education. An insurance concept designed to give individuals greater control in the use of their healthcare dollars. MSAs combine a highdeductible major medical insurance policy (which usually costs less than a low-deductible policy) with an employer-funded healthcare savings account. Employers can draw from the account to cover their first dollar healthcare expenses. The funds used to create the account come from the savings realized by purchasing the high-deductible insurance plan. That body which, according to the medical staff standard of the JCAHO, includes fully licensed physicians, and may include other licensed individuals permitted by law and by the hospital to provide inpatient care services independently in the hospital. These individuals together make up the organized medical staff. A person who, by current income standards, is not poor but lacks the financial resources to afford necessary medical services. Geographic location that has insufficient health resources to meet the medical needs of the resident population. The federal health insurance program for people age 65 and over and those with certain chronic disabilities. Medicare has two parts. Part A (hospital insurance) pays for most inpatient hospital care and some follow-up care. Part B (medical insurance) pays for most physicians services. Patients are responsible for deductibles and co-payments. Medicare pays hospitals for patient care using a prospective pricing system (PPS) based on diagnosis-related groups (DRGs). Established in 1990 by Congress, this five-person board reviews hospital requests for geographic reclassification for Medicare prospective payment system purposes. Reclassification occurs when hospitals are located in adjacent county and pay wages equal to at least 85% of those paid by hospitals in the area for which classification is being represented.
Medical Staff Organization
Medically Indigent Medically Underserved Area Medicare
Medicare Geographic Classification Review Board
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Medicare Supplemental Income Medicare Payment Advisory Commission (MedPAC)
Private insurance policies that pay some or all of Medicares deductibles and copayments. In 1997 Congress approved the merger of The Physician Payment Review Commission and the Prospective Payment Assessment Commission to form MedPAC. This body provides policy advice and technical assistance concerning Medicare and other parts of the healthcare system. It conducts independent research, analyzes legislation and makes recommendations to Congress. A registered professional nurse with post-graduate education in pre-natal care and the delivery of babies. In New Jersey, certified nurse midwives must have a masters degree in nursing and be certified by the N.J. Board of Medical Examiners. Extent of illness, injury or disability in a defined population. An organizational affiliation among two or more healthcare organizations. Multi-hospital systems may be vertically or horizontally integrated. The tie among the institutions can be through ownership, lease, contract management or vertical integration. An approach to caring for the elderly that involves a multidisciplinary team of professionals having the goal of providing comprehensive, integrated care. The team often includes a physician, nurse and social worker working closely together and, depending on the patients needs, may also include an occupational, physical or other therapist, psychiatrist or psychologist. (see Geriatric Assessment Team) Federal health insurance program designed to provide comprehensive benefits to the majority of the population. An alert or flagging system created to facilitate a more comprehensive review of professional credentials. It assists state licensing boards, hospitals and other healthcare entities in conducting intensive independent reviews of the qualifications of the healthcare practitioner they seek to license or grant clinical privileges. Information reported to the bank is confidential except to those legally allowed to access it.
Midwife, Certified Nurse
Morbidity Multi-Hospital System
Multi-Disciplinary Team
National Health Insurance National Practitioner Data Bank
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Neonatal
An infants life from the hour of birth through the first 27 days, 23 hours and 59 minutes (this constitutes the definition of newborn). The use of radioisotopes to diagnose and treat patients. Applications can provide images (pictures) for diagnostics and others provide diagnostic tests and treatments for disease. A registered professional nurse with graduate level education in a nursing specialty (i.e., family health, pediatrics, gerontology). In N.J., NPs are licensed by the State Board of Nursing and are qualified to carry out expanded healthcare evaluations and treatment plans. Also known as advanced practice nurse. The inpatient census, generally expressed as a percentage of total beds that are occupied at any given time. This was once the most common type of commercial malpractice insurance. It provides coverage for liability arising from malpractice that occurred while the policy was in effect, regardless of when the claim or potential loss is reported. For example, if a claim is filed after an occurrence policy has expired, but the claim alleges an act of malpractice that occurred when the policy was in force, the occurrence policy will cover the management and payment of the claim. Insurance coverage is provided for all events that occur while the policy is in force, regardless of when the claim is filed/ reported/ made. A financial plan for the expected revenues and expenditures of the day-to-day operations of the hospital. Introduced in 1997, ORYX is an initiative of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It seeks to integrate outcome and other measurement data into the accreditation process.
Nuclear Medicine
Nurse Practitioner (NP)
Occupancy Occurrence Coverage
Occurrence Policy
Operating Budget ORYX
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Outcome and Assessment Information Set (OASIS) Outlier Outpatient PGY I, II, III, IV, V
CMS developed a data set for use in monitoring outcomes of adult home health care patients. Providers who use and pass OASIS measurements are Medicare-certified home health agencies. A patient that generates unusually high costs or requires an unusually long stay. A person who receives care without being admitted to the hospital for overnight or longer stay. Post Graduate Year I, II, III, IV and V; a term used to identify a medical school graduates year of post-graduate clinical training. (Previously known as interns and residents.) (see interns, residents) A technician with 18 months training in emergency medicine. Paramedics administer emergency care out of the hospital. The refusal to examine, treat and stabilize any person irrespective of payer/class who has an emergency medical condition, or is in active labor or contractions once that person has been presented at a hospital emergency room or emergency department. (see EMTALA) A questionnaire use to solicit the perceptions of patients regarding their stay and/or service in a healthcare facility, i.e., waiting time, access to treatment, food, staff, etc. A CMS mandated program that is carried out by the Peer Review Organization (PRO) for each state. The objective of PEPP is to reduce payment errors made under the prospective payment system (PPS). PRO is comprised of physicians operating independently of the hospital and under contract with the federal government to review the hospital care of Medicare patients. The PRO in New Jersey is operated by The Peer Review Organization of New Jersey, Inc.
Paramedic Patient Dumping
Patient Satisfaction Survey Payment Error Prevention (PEPP)
Peer Review Organization (PRO)
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Performance Measurement System
A clinical outcome measurement model developed in 1993 by NJHA and QuadraMed Corp. The system provides hard-copy reports providing comparisons to peer groups and riskadjusted predicted rates based on actual patient data. Also available in an electronic version that can target specific results down to individual physician practice patterns or patient profile analysis. Room, board and the provision of some assistance with activities of daily living (i.e., grooming, bathing, eating). Person who provides healthcare services (customarily performed by a physician) under responsible supervision of a qualified licensed physician. Physician Assistants must complete an accredited education program and be licensed by a recognized agency or commission. In New Jersey PAs are licensed by the N.J. Board of Medical Examiners. A legal entity formed by a hospital and a group of physicians, usually for the purpose of obtaining managed care contracts directly with employers. The PHO serves as a collective negotiating and contracting unit. A type of managed care plan in which beneficiaries have the option of choosing to obtain medical services from the provider of their choice, or a primary physician from the plans panel of physicians. There is a financial incentive to select a primary physician from the plans panel. An imaging technique that tracks metabolism and responses to therapy used in oncology, neurology and cardiology. This system is especially effective in evaluating brain and nervous system disorders. A major component of general retirement benefits that cover healthcare cost not paid by Medicare (in part or fully). They are provided to retirees through the employers group health plan and the set of benefits varies according to eligibility, services covered and payment.
Personal Care Physician Assistant (PA)
Physician-Hospital Organization (PHO)
Point Of Service (POS)
Positron Emission Tomography (PET)
Post Retirement Health Benefits (PRHBs)
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Point-Of-Service Plan
A type of health plan allowing the covered person to choose a service from a participating or non-participating provider; there is a financial incentive to use participating providers. A statistical summary of population-specific healthcare data used to assess healthcare delivery. The state of being able to continue health insurance coverage when changing job or residence, without a waiting period or having to meet additional deductible requirements. PPOs are organizational entities that have a contractual arrangement between healthcare providers (including institutions and professionals) and employers, insurance carriers or third-party payers to provide healthcare services to a defined population. In managed care the term refers to the physician responsible for coordinating and managing the healthcare needs of members, including hospitalization and specialist referrals. A not-for-profit hospital is owned and operated by a private corporation whose excess of income over expenses is used for hospital purposes rather than return to stockholders or investors as dividends. They are sometimes referred to as voluntary hospitals. Assuring the organizational processes meet quality, cost and productivity processes means they can be defined, measures and systematically proved. Groupings of related business activities. A hospitals product line might be as broad as cardiac care or surgical care, or as specific as care by DRG or product code. The relationship between service input and output. Typical productivity measures for labor cost include full-time equivalent positions (FTE) per patient day, FTEs per admission and FTEs per bed.
Population Profile Portability
Preferred Provider Organization (PPO)
Primary Care Physician
Private Not-For-Profit
Process Management
Product Line
Productivity
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Professional Liability Insurance Prospective Payment
Protection for real or alleged errors committed in the practice of a profession (i.e., Hospital Professional Liability). A method of payment for healthcare services in which the amount of payment for services is set prior to the delivery of those services and the hospital (or other provider) is at least partially at risk for losses or stands to gain from surpluses that accrue in the payment period. Prospective payment rates may be per service, per capita, per diem or per case rates. An independent commission established by the Social Security Amendments of 1983 (Public Law 98-21), the law that created Medicares DRG-based prospective payment system (PPS), to advise the Secretary of Health and Human Services on the annual update factor and on adjustments of DRG classifications and weights. Medicares system, adopted in the Social Security Amendments of 1983, or by which hospitals are paid a fixed, prospectively set price for each Medicare beneficiary treated as an inpatient according to the patients DRG. A hospital or healthcare professional who provides healthcare services to patients. May be an entity (hospital, nursing home or other) or a person, such as a physician or nurse. Healthcare systems owned and operated by providers that integrate a wide spectrum of services and contract with various entities on a managed care basis. Also known as a Provider Sponsored Network (PSN). The process used to determine the quality of care, to develop and maintain programs to keep it at an acceptable level and to correct patterns of care that fall below that level. System that strives to prevent crises rather than manage them.
Prospective Payment Assessment Commission (ProPAC)
Prospective Payment Pricing) System (PPS)
Provider
Provider - Sponsored Organization (PSO)
Quality Assurance
Quality Improvement System Quality Improvement Team
Usually an ad hoc team from multiple departments, typically managerial or professional members, whose purpose is to improve quality in a specific area.
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Quality of Care RFP
The degree to which patient care meets accepted principles and standards of practice. Request for Proposal. An RFP lists project specifications and application procedures for contracts or grant programs. Used most frequently by local, state and federal agencies, RFPs are sent to organizations that might be qualified to participate in the grant program. Prospective review by a government or private agency of a hospitals budget and financial data, performed for the purpose of determining the reasonableness of the hospital rates and evaluating proposed rate increases. Physicians fee limitations determined on the basis of the lowest of actual charge, customary charge or prevailing charge and other profiles added under the Tax Equity and Fiscal Responsibility Act of 1982 (Public Law 97-248) and Medicare provider-based physician regulations. The seven classes of waste usually derived from direct patient care or research as defined by the federal Waste Tracking Act WASTE (RMW) and the New Jersey Waste Tracking Act (NJAC 7:26-3A.6). It does not include ordinary business and kitchen waste nor medical waste that does not transmit disease or raise serious aesthetic concerns if disposed of improperly. A facility that provides medical, health-related, social, and/or vocational services to disabled persons to help them attain their maximum functional capacity. A type of insurance purchased by primary insurers (insurers that provide healthcare coverage directly to policy holders) from other secondary insurers, called Areinsurers, to protect against part of all losses the primary insurer might assume in honoring claims of its policyholders.
Rate Review
Reasonable Charges
Regulated Medical Waste
Rehabilitation Facility
Reinsurance
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Relative Value Unit
Unit of measure designed to permit comparison of the amounts of resources required to perform various services within a single department or between similar departments in various hospitals by assigning weight to such factors as personnel time, level of skill and sophistication of equipment required to render service. A resident is a graduate physician in post-graduate hospital clinical training. Formerly, the first year after graduation was referred to as an internship and thereafter, as residency. The years are now referred to as post-graduate years (PGY) I V. (see PGY I, II, III, IV and V) Patient care provided intermittently in the home or institution in order to provide temporary relief to the family home care giver. Funds that have been designated to be spent for a specific purpose. An insurance and quality control-related discipline responsible for identification and assessment of loss potential, control and funding, and also includes the management of workers compensation and claims professionals. A set of federal regulations which clarify and ease the restrictions of the Medicare/Medicaid Fraud & Abuse Statutes. The regulations specify certain types of provider payment arrangements that are not subject to criminal prosecution or civil sanctions. A hospital-based program that provides intensive medical, nursing and rehabilitation services to individuals who spend the day at the hospital and return home in the evening and who would need to be in the hospital where the day program is not available. Services provided are more intensive in nature than those commonly provided by adult day care programs.
Resident
Respite Care Restricted Funds Risk Management
Safe Harbor Regulations
Same Day Surgery
Page 28
Self Insurance
This method retains the risk within a hospital or group of hospitals while providing a funding mechanism (similar to a trust fund) to cover the cost of litigation and malpractice liability losses. Another form of self-insurance is non-funded self-insurance, or going bare. Under this method the hospital makes no prearrangement whatsoever to cover the payment of malpractice liability losses or litigation or claims management costs. Rather, the hospital pays its malpractice losses and related expenses from its operating capital. A volunteer program making particular efforts to recruit and involve older adults. Administrative, clinical or service functions that are common to two or more healthcare institutions, which are used jointly or cooperatively by them in some manner for the purpose of improving service, containing cost and/or effecting economies of scale. Nursing or other rehabilitative services provided under the direction of a physician or an approved professional. To be reimbursed by Medicare, this care must meet Medicare standards and be delivered in a Medicare-approved facility. A facility that provides acute medical care and continuous nursing care services and various other health and social services to patients who are not in the acute phase of illness but who require primarily convalescent, rehabilitative and/or restorative services. The care may be delivered in a freestanding facility or in a unit of a hospital. Credit-card-sized, they contain a small semiconductor chip, capable of holding an individuals complete medical history and other healthcare information. Physicians are employed to provide services to subscribers at the HMOs corporate location or its multiple satellite locations. Subscribers choose a primary care physician from the physicians employed by the HMO.
Senior Volunteer Program Shared Services
Skilled Nursing Care
Skilled Nursing Facility (SNF)
Smart Card
Staff Model HMO
Page 29
Staffing Ratio State Health Plan
The total number of hospital employees (full-time equivalents, or FTEs) divided by the average daily census. Required by the Health Care Cost Reduction Act of 1991, the State Health Plan is a document, prepared by the State Health Planning Board and the Department of Health, that is intended to identify unmet health needs in an area by service and location, and to serve as the basis on which all certificate of need applications will be reviewed and approved. Although the State Health Plan was originally given the force and effect of law, the Legislature revised the statutes in 1992 to make the State Health Plan only an advisory document. Established by the Health Care Cost Reduction Act of 1991, the State Health Planning Board serves as the planning advisory board to the Department of Health. The Board is responsible for annually preparing and revising the State Health Plan. Financial report showing liquid assets increasing and decreasing (balance of cash accounts). Also known as excess risk insurance. An insurance policy designed to reimburse a self-funded arrangement of one or more small employers for catastrophic, excess or unexpected expenses; neither the employees nor other individuals are third-party beneficiaries under the policy. Medical and skilled nursing services provided to patients who are not in an acute phase of illness but require a level of care higher than that provided in a long term care setting. A health care facility separated physically from a hospital that provides prescheduled outpatient surgical services. Unused acute care beds that can be swung to long-term care beds within the same hospital. A hospital that has an accredited medical residency training programs and is often affiliated with a medical school.
State Health Planning Board
Statement of Change in Fund Balance Stop Loss Insurance
Subacute Care
Surgicenter Swing Beds Teaching Hospital
Page 30
TEFRA
In 1982, Congress passed P.L. 97-248, Tax Equity and Fiscal Responsibility Act. This law limited the amount of all hospital inpatient costs per discharge and mandated the development of a prospective pricing system (PPS). The PPS reimbursement diagnosis - related groups, or DRG. There are 467 DRGs and the government reimburses the hospital a flat rate for each DRG and considers that rate as payment in full. The rate for each DRG is established before the patient is treated, hence the term prospective pricing. A meeting held at two or more different locations where participants are able to communicate with each other in real time using telecommunications. A video teleconference allows visual communication between participants while an audio teleconference is limited to voice communications. Medical care of a highly technological and specialized nature provided in a medical center or teaching and research institution for patients with severe, complicated or unusual medical problems. A payer that neither gives nor receives the care (the patient and the provider are the first two parties). Usually an insurance company or government agency. A civil remedy to a negligent or intentional civil wrong excluding a breach of contract. The injured person may sue the wrongdoer for damages. A long-term corporate strategy focusing on the continuous improvement of key work processes that ultimately improves products and services and satisfies the needs and expectations of customers. A fixed premium for a year through which the subscribers receive medical care from their chosen provider. The healthcare provider is paid for services rendered at essentially a rate equivalent to usual and customary fees.
Teleconference
Tertiary Care
Third-Party Payer
Tort
Total Quality Management (TQM)
Traditional Insurance
Page 31
Trauma Center Triage Ultrasound Uncompensated Care
A hospital, specifically designated within a region, that is equipped and staffed to receive critically ill or injured patients. A system of assigning priorities of medical treatment on the basis of urgency, chance for survival or other indicators. A high frequency (pitch above human hearing) imaging technique also called sonography. Care for which the provider is not compensated. Generally, uncompensated care includes charity care and bad debts (uncollectible charges to patients who have the ability to pay). (see charity care) Uniform billing form submitted to the N.J. Department of Health and Senior Services. Every acute care hospital in the state submits this data for all inpatients and all same-day surgery patients. A HCFA initiative that involves collection of approximately 1,800 data elements that describe patient demographic characteristics, clinical history, clinical findings and therapeutic intervention. The data is obtained from the medical records of Medicare beneficiaries Trained, unlicensed staff who assist professional staff in the delivery of patient care. Any funds not designated for a specific purpose. Sometimes referred to as a minor emergency facility or urgicenter, it is a free-standing emergency care facility. A hospital, a physician or a corporate entity may sponsor it. The traditional method of determining the prevailing physician fees in a given area.
Uniform Bill - UB-92
Uniform Clinical Data Set (UCDS)
Unlicensed Assistive Personnel (UAP) Unrestricted Funds Urgent Care Center
Usual, Customary & Reasonable Charges (UCR)
Page 32
Utilization Review
A systematic program of reviewing and managing patient care in pursuit of cost-effective use of hospital services including patient days, diagnostic tests, medications and surgical procedures. JCAHO, Medicare and other external bodies require hospital utilization management programs. Some third-party payers have external utilization review organizations to review services. A healthcare system that provides a range of continuum of care such as outpatient, acute hospital, long-term, home and hospice care, usually through partnerships, joint ventures and contractual arrangements. (see multi-institutional system, horizontal organization and integrated delivery system)
Vertical Integration
Page 33
FREQUENTLY USED ABBREVIATIONS ently Used Abbreviations/Acronyms

AAHP AARP ACHE ADC ADL ADSPN AGMEC AHA AIDS ALJ ALOS AMA AMA ANA AOA AOHA AONE
American Association of Health Plans American Association of Retired Persons American College of Healthcare Executives Average daily census Activities of daily living Association of Diploma Schools for Professional Nursing Advisory Graduate Medical Education Council American Hospital Association Acquired immune deficiency syndrome Administrative law judge Average length of stay Against medical advice American Medical Association American Nurses Association American Osteopathic Association American Osteopathic Hospital Association American Organization of Nurse Executives
Page 34
APD ASAE BC/BS BME CDC CE CEO CFO CHIN CICU CMS CN or CON CNS COB COBRA COHE COO CPA CPR CRNA
Adjusted patient day American Society of Association Executives Blue Cross and Blue Shield Board of Medical Examiners Centers for Disease Control Continuing education Chief Executive Officer Chief Financial Officer Community health information network Coronary intensive care unit Centers of Medicaid and Medicare Services (formerly HCFA) Certificate of Need Clinical Nurse Specialist Coordination of benefits Consolidated Omnibus Reconciliation Act of 1985 College of Osteopathic Healthcare Executives Chief Operating Officer Certified Public Accountant Cardiopulmonary resuscitation or customary, prevailing and reasonable (charges) Certified Registered Nurse Anesthetist
Page 35
CT CY D&O DHSS DME DNR DOH DOJ DOL DOT DRG DSH EAB EBT ECF ED EMS EMT EMTALA EPA
Computed tomography Calendar year Directors and officers Department of Health and Human Services Director of Medical Education or durable medical equipment Do not resuscitate Department of Health and Senior Services Department of Justice Department of Labor Department of Transportation Diagnosis Related Group Disproportionate share hospital Engineering Advisory Board Employee Benefit Trust Extended care facility Emergency Department Emergency medical system Emergency Medical Technologist Emergency Medical Treatment and Active Labor Act Environmental Protection Agency
Page 36
ER ERISA ESRD FACHE FDA FMG FTC FTE FY GAO GME GNP HCAB HCFA HCFFA HCIC HEFCU HFMA HHAA HHS
Emergency room (now referred to as the Emergency Department - see ED) Employee Retirement Income Security Act End stage renal disease Fellow of American College of Healthcare Executives Food and Drug Administration Foreign medical graduate Federal Trade Commission Full-time equivalent Fiscal year General Accounting Office Graduate medical education Gross national product Health Care Administration Board Health Care Financing Administration (renamed CMS in 2001) Health Care Facilities Financing Authority Health Care Insurance Company Healthcare Employees Federal Credit Union Healthcare Financial Management Association Home Health Agency Assembly of NJ Health and Human Services (Dept. of)
Page 37
HHS HIAA HIP HIPAA HMO HRET HRSC ICD-9-CM ICF ICU IDS IMG IPA IPA IRA IV JCAHO JNESO LAB LOS
Home health services Health Insurance Association of America Health insurance plan Health Insurance Portability and Accountability Act of 1996 Health Maintenance Organization Health Research and Educational Trust Hospital Rate Setting Commission International Classification of Diseases, 9th revision Intermediate care facility Intensive care unit Integrated delivery system International Medical Graduate Independent Practice Association Individual practice arrangement/association Individual retirement account Intravenous Joint Commission on Accreditation of Healthcare Organizations New Jersey Nurses Economic Security Organization Local Advisory Board (no longer applicable in New Jersey) Length of stay
Page 38
LPN LTC LTAC MAHC MD MHA MICU MONOC MPH MRI MSA MSNJ NA NJAC NJANPHA NJHA NJHC NJHO NJSA NJSNA NP
Licensed Practical Nurse Long-term care Long term acute care hospital Middle Atlantic Health Congress Medical Doctor Master of Healthcare Administration Mobile intensive care unit Monmouth Ocean Hospital Shared Services Association Master of Public Health Magnetic resonance imaging Medical savings account Medical Society of New Jersey Nursing assistant New Jersey Administrative Code New Jersey Association of Non-Profit Homes for the Aging New Jersey Hospital Association New Jersey Healthcare Congress New Jersey Hospice Organization New Jersey Statutes Annotated New Jersey State Nurses Association Nurse Practitioner
Page 39
OBRA OMB OP OR OSHA OT P&L PA PAC PAT PBM PDR PGY PHO PIC PIP PPO PPS PRHB PRO ProPAC
Omnibus Budget Reconciliation Act Office of Management and Budget Outpatient Operating room Occupational Safety and Hazard Agency Occupational therapy Profit and loss Physician assistant Political Action Committee Preadmission testing Pharmacy benefit management company Physicians Desk Reference Post graduate year Physician-hospital organization Princeton Insurance Company Periodic interim payments Preferred provider organization Prospective payment system Post retirement health benefit Professional Review Organization (see QIO) Prospective Payment Assessment Commission
Page 40
PSN PSO PSRO PT QA QIO R&D RN RPh RPT RRA RRT RT SCHIP SIDS SNF SNJHC TEFRA TQM TRO TSA
Provider sponsored network Provider-sponsored organization Professional Standards Review Organization Physical therapy Quality assurance Quality Improvement Organizations Research and development Registered Nurse Registered Pharmacist Registered Physical Therapist Registered Record Administrator Registered Respiratory Therapist Respiratory Therapist/Therapy State Childrens Health Insurance Program Sudden infant death syndrome Skilled nursing facility (pronounced sniff) Southern New Jersey Hospital Council Tax Equity and Fiscal Responsibility Act Total Quality Management Temporary restraining order Tax-sheltered annuity
Page 41
UAP UP-92 UBPS UCR UMDNJ UR URL VA VHA WC WWW YTD
Unlicensed assistive personnel Uniform Billing form, modified in 1992 Uniform bill patient summary Usual, customary and reasonable charges University of Medicine and Dentistry of New Jersey Utilization review Uniform Resouce Locator Veterans Administration Voluntary Hospitals of America Workers compensation World Wide Web Year-to-date
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760 Alexander Road PO Box 1 Princeton, NJ 08543-0001 609-275-4044 www.njha.com

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Glossary of Healthcare Terms and Abbreviations

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HEALTHCARE TERMS & ABBREVIATIONS

H EALTHCARE T ERMS & A BBREVIATIONS

Glossary of Healthcare Terms & Abbreviations

Glossary of Healthcare Terms.................................................................. 1

Frequently Used Abbreviations/Acronyms ............................................ 31

Glossary of Healthcare Terms & Abbreviations

Glossary of Healthcare Terms & Abbreviations