This action might not be possible to undo. Are you sure you want to continue?
HEALTHCARE TERMS & ABBREVIATIONS
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.
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 today’s most pressing healthcare issues.
Gary S. Carter, FACHE President and CEO New Jersey Hospital Association
Glossary of Healthcare Terms & Abbreviations
Introduction ............................................................................................ iii
Glossary of Healthcare Terms.................................................................. 1
Frequently Used Abbreviations/Acronyms ............................................ 31
Glossary of Healthcare Terms & Abbreviations
It is through such revisions that the Council on Hospital Governance will continue to help non-healthcare professionals participate in meaningful healthcare dialogue. finance and computer technology. finance. one must also be fluent in the language of business. The Glossary is designed as an easy-to-use reference. Future revisions of the Glossary will be published as needed. Users of the Glossary will find words and terms dealing with medicine. Any commonly used abbreviations or acronyms for the words and terms are provided. titled the Glossary of HEALTHCARE Terms and Abbreviations. the language of healthcare was almost exclusively within the medical domain. Now. A list of frequently used general healthcare abbreviations and or acronyms comprise the second section. The NJHA Council on Governance’s first glossary. Glossary of Healthcare Terms & Abbreviations III . Now. it reflects hospitals’ movement beyond their own four walls. 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. defined within the context of the healthcare world. terms and abbreviations commonly used by professionals involved in New Jersey’s hospital and healthcare industry. The first section of the Glossary includes definitions of words and terms. At one time. but rather a glossary of words. for example.INTRODUCTION T he language of healthcare has changed drastically over the past two decades. It is not an allinclusive healthcare dictionary. was called Glossary of HOSPITAL Terms and Abbreviations. insurance and the computer world.
transferring from bed to chair. dressing. 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.Glossary of Healthcare Terms APD Access Accounts Receivable Accreditation Adjusted patient day. (see JCAHO) Basic self-care activities. An accounting method for modifying the definition of inpatient days to include outpatient revenues. health monitoring. A program that provides a combination of health. Potential and actual entry of a population into the healthcare delivery system. including eating. a noon meal and transportation. Accreditation Manual For Hospitals Activities Of Daily Living (ADL) Acute Care Adult Day Care Glossary of Healthcare Terms & Abbreviations Page 1 . personal care. ADLs are widely used as a measure of evaluating independent functional status. Some programs also provide primary healthcare and rehabilitation services. (see JCAHO) A JCAHO publication published annually. Generally refers to inpatient hospital care of a short duration as opposed to ambulatory care or long-term care for the chronically ill. hospital standards and scoring guidelines used to determine levels of compliance with the standards. bowel and bladder control and independent ambulation. Services may include comprehensive assessment. Generally refers to the evaluation by the Joint Commission on Accreditation of Health Care Organizations. consisting of policies and procedures relating to hospital accreditation surveys. recreational and social services to older adults during the day. occupational therapy. bathing.
day surgery and outpatient diagnostic services. Services provided to hospital patients in the course of care. physicians= assistants and others. usually fatal dieseace caused by a virus hat destroys the body’s ability to fight off illness. Member of a hospital auxiliary who may or may not be an inservice volunteer within the affiliated hospital. (see HMOs. other than room. If the physician does not accept assignment. pharmacy and rehabilitation therapy services. The formula is 95 percent of Medicare Part A and B costs per person by county.Advanced Directive AIDS see Living Will Acquired Immune Deficiency Syndrome is an incurable. Professionally educated and certified non-physician healthcare providers. respiratory therapists. Refers to alternatives to fee-for-service systems for delivering healthcare. A plan to impose uniform prices of medical services. PHOs. the patient is billed for the difference between the Medicare charge and his or her usual charge. regardless of who is paying. AIDS causes recurrent infections or secondary diseases affecting multiple body systems. independent practice associations (IPAs) and preferred provider organizations (PPOs). medical and nursing services. including nurse practitioners. including primary care. All-Payer System Allied Health Professionals Alternative Delivery Ambulatory Care Ancillary Services Assignment Auxilian Average Adjusted Per Capita Cost (AAPCC) Glossary of Healthcare Terms & Abbreviations Page 2 . same. radiology. Examples include health maintenance organizations (HMOs). board. certified registered nurse anesthetists. 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. such as laboratory. IPAs. PPOs and PSOs) Care delivered on an outpatient basis. The formula used for determining Medicare reimbursement for managed care.
Compact Disc-Read Only Memory. that is not held for sale in the regular course of business. The practice of charging an all-inclusive package price for all medical services associated with selected procedures. as in converting acute-care beds to long-term care beds. also known as a Community Health Management Information System (CHMIS). Allocation of beds from one level of care to another. Depreciable property of fixed or permanent nature. The system also contains a data repository for purchasing and quality reports. physicians. such as buildings or equipment. Community Health Information Network.Balance Sheet Bed Conversion Bench Marking Biohazard Statement of assets and liabilities. An electronic information system that transmits healthcare data among hospitals. 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. noninvasive method of radiological diagnosis that creates “images” of the body in a computerized display. An advanced. The process of continually measuring products. Biomedical Ethics Board Certified Bundled Billing CD-ROM CHIN CT or CAT Scan Capital Asset Glossary of Healthcare Terms & Abbreviations Page 3 .000 printed pages. They are about the same size and appearance as audio compact discs. Computerized axial tomography. bandages and other contaminated materials. A biological or chemical agent or a condition that is harmful to humans or other living things. one disc can hold 300. A term used to describe philosophical questions involving morals. values and ethics in the provision of healthcare. these are discs inscribed with non-erasable data. services and practices against major competitors or industry leaders. employers and third-party payers within a community. A term often used in biohazardous materials like used needles.
A system of assessment. such as plant and property. 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. fee. A high case mix index refers to a patient population more ill than average. A method of paying for health services on a per-person basis as opposed to fee-for-services basis. and some on their utilization of services.Capital Cost Hospital’s costs for major fixed or durable assets. (see alternative delivery systems. monitoring the individual’s progress through the system. A case manager acts as a client advocate. A measure of patient acuity reflecting different patients’ needs for hospital resources. PPOs) Maximum allowable limits placed on revenue or rates by the federal or state government. Capital Formation Capitation Caps Captive Insurance Cardiac Catheterization Carve-Out Case Management Case Mix Glossary of Healthcare Terms & Abbreviations Page 4 . some are based on patients’ diagnoses or the severity of their illnesses. IPAs. and the coordination of payment and reimbursement for care. A minimally invasive procedure used to diagnose disorders of the heart. Services not included in a health plan. lungs and great vessels. movable equipment. HMOs. usually higher. (see depreciation) Methods for obtaining and accumulating funds for capital needs. treatment planning. HMOs charge subscribers a fixed fee per person or family for comprehensive coverage. according to client needs. and working capital. referral and follow-up that ensures the provision of services. For example.. but available from another supplier or agent at a different. There are many ways of measuring case mix.
A certificate issued by the N. A charge generally includes the cost plus an operating margin. The elected or appointed leader of the hospital medical staff organization. Free medical care rendered to individuals who do not have the ability to pay for such care. acquire major medical equipment or offer a new or different health service. Average number of inpatients. receiving care each day during a reported period. Geographic area defined and served by a hospital and delineated on the basis of such factors as population distribution. negotiated rate or government-set rate (e. The amount billed by a hospital for services provided.. Methods used on the Internet for groups of like-minded and/or individuals to talk to each other.J. PPS). 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. Department of Health and Senior Services. Many payers pay a discounted rate.g. to a hospital seeking permission to modify its facility. Catchment Area Census Centers for Medicaid and Medicare Services (CMS) Certificate Of Need (CN) Charges Charity Care Chat Bulletin Board ListServ Chief Of Staff Glossary of Healthcare Terms & Abbreviations Page 5 .Computerized Axial Tomography (CAT) Catastrophic Illness Diagnostic equipment that produces a cross section image of the body. Medicare and State Children’s Health Insurance Program (SCHIP). natural geographic boundaries or transportation accessibility. excluding newborn. Formerly known as HCFA (Health Care Financing Administration) this is the governmental department that administrates Medicaid.
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. experience and current clinical competence. based on medical staff recommendations. pediatrics and family medicine. Requirement of an insurance policy or prepayment plan that the beneficiary pay a predetermined portion or percentage of the provider’s charges. an arrangement wherein no new applicants are accepted. education. 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. 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. In a departmentalized hospital. As applied to the medical staff as a whole. bureaus and agencies of the federal government that is promoted in the Federal Register. within well-defined limits.Children’s Health Insurance Plan (CHIP) State Children’s 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. A codified collection of regulations issued by various departments. obstetrics-gynecology. provided the coverage is continuous with the insurer. according to an individual’s professional license. surgery. Claims-Made Policy Clinical Department Clinical Pathway Clinical Privileges Closed Staff Code of Federal Regulations Co-Insurance Glossary of Healthcare Terms & Abbreviations Page 6 . the medical staff organization is subdivided into major divisions such as medicine. In New Jersey the program is NJ KidCare. Hospital privileges must be delineated individually for each practitioner by the hospital board. see critical pathway The right to provide medical or surgical care services in the hospital. training.
There are also similar non-federally funded community health programs. meal service. Prudential) offering health and other types of coverage. Public Health Service that provides primary and preventive health services. enabling a community-wide establishment of health priorities and facilitating collaborative actionplanning directed toward improving the community’s health status. Dynamic process undertaken to identify the health.e. Glossary of Healthcare Terms & Abbreviations Page 7 . community-based ambulatory healthcare program organized and funded by the U. Individual apartments usually include kitchen facilities. often called neighborhood health centers. private insurance carriers (i. a security system. The community health assessment process involves multiple sectors of the community.S. Activities initiated by not-for-profit hospitals to benefit the hospital’s 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.Commercial Carriers Community Benefits For-profit. 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. problems and goals of the community. They are usually located in an area with scarce health services or with a population with special health needs. sponsored by local hospitals and/or community foundations. A secondary illness. socialization opportunities or transportation. This method spreads the cost of illness evenly over all subscribers rather than charging the sick more than the healthy. Services that meet the total healthcare needs of a patient. 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. A local. Aetna.
or the hospital becoming a subsidiary of a new parent corporate structure. such as the conversion from not-for-profit status to for-profit. Negotiated discounts from hospital-established charges.” The concept at heart of the Total Quality Management philosophy is that quality is never static. and board and care homes. for a specific purpose. 2) in-home care such as home-delivered meals. Corporate Restructuring Cost Accounting Glossary of Healthcare Terms & Abbreviations Page 8 . home health services. but is a constantly moving target. homemaker services. Restructuring generally involves either the formation of corporations legally independent of the hospital. An accounting system arriving at charges by healthcare providers based on actual costs for services rendered. constantly open to improvement. and 6) acute care services. 5) nursing homes. that functions under a set of bylaws. shopping assistance. This usually entails a complete change of mission after a new line of business or service displaces a core activity. 3) community-based services such as adult day care. Continuous Quality Improvement Continuum Of Care Contractual Allowances Conversion A major change that a hospital undertakes. shared housing. as well as in institutions. personal care. Used by JCAHO to describe its “Agenda for Change. Continuum includes: 1) community services such as senior centers.Consortium Formal voluntary alliance of institutions. 4) non-institutional housing arrangements such as congregate housing. 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. or the conversion of an acute care facility to ambulatory care. A comprehensive system of long-term care services and support system in the community. usually from the same geographic area. chore services and friendly visiting.
Only critical components . This is key information easy to read to indicate areas of success and those that need improvement. The process of checking a practitioner’s references and documenting his/her credentials. Treatment regimen agreed on by a consensus of clinicians. Increasing the charges to one group of hospital patients to cover or subsidize losses on other groups of patients. Having consumers pay a portion of the cost of their healthcare bills or insurance premiums. A variety of indicators displayed visually. DRGs are the used by the federal government for Medicare’ prospective pricing system. were the basis for New Jersey’s payment system.items that directly affect care . Diagnosis-related group(s).are part of the critical pathway. including training and education. Dashboards often cover clinical quality. It includes only those few vital elements proven to affect patient outcomes. The hospital governing board has ultimate accountability for physician credentialing but usually delegates the process to the medical staff committee. A system for classifying hospital patients based on their clinical condition (diagnosis or surgical procedure).Cost Finding Determining how it much it actually costs to provide a given service. licensure verification and malpractice insurance. experience. much like a car’s dashboard. 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. patient satisfaction. Usually requires a cost accounting system or a retrospective cost study. age. full time employees. revenue. and until 1993. demonstrated ability. and whether they had any other illnesses (complications or comorbidities). a predetermined price is set for each of over 500 DRGs. etc. Cost Sharing Cost Shifting Credentialing Critical Pathway DRG(s) Dashboard Deductible Glossary of Healthcare Terms & Abbreviations Page 9 .
thus obviating the need for a duplicative Medicare accreditation survey. equipment and vehicles. treatment or continued stay is inappropriate according to a set of guidelines. diagnostic test. 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. 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). This coverage does not extend to dishonest acts.Deemed Status A hospital is “deemed qualified” to participate in the Medicare program if it is accredited by the JCAHO. 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. Discharge planning assists patients and their families in arranging services they will need after discharge from a hospital. Accumulated depreciation is the total amount of depreciation of the hospital’s financial books. 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. property and equipment) over its useful life. Information that may be legally obtained by a party to a lawsuit. Annual depreciation is the amount charged each year as expense for such assets as building. The amortization of the cost of a physical asset (plant. Inner city and rural hospitals typically fall into this category. Denial Depreciation Directors and Officers Liability Insurance Discharge Planning Discoverable Disproportionate Share Hospital (DSH) Glossary of Healthcare Terms & Abbreviations Page 10 . Reimbursement is at a higher rate under the prospective payment system for inpatient services to cover the higher cost of caring for these patients. A hospital that provides care to a large number of patients who cannot afford to pay or do not have insurance.
A listing of prescription medications approved for use by and in a hospital. a process of client identification and a quick response team or mechanism. An emergency alarm and response system designed for functionally impaired persons (particularly the elderly) living in the community. Emergency Medical Treatment and Active Labor Act. also used to identify those prescription medications approved for use and/or coverage by health insurance plans. The system includes an electronic communication unit that is easily activated (in the home) when there is an emergency. but is not limited to. a central emergency station located in a hospital or similar facility that is responsible for receiving incoming alarms. Refers to a systematic. Diagnosis and Treatment Program for children through maternal and child health programs designed to determine illnesses that handicap children. Emergency Medical Systems. also known as COBRA Aanti-dumping” law. and communications systems so that severely ill or injured persons are transported and treated promptly and appropriately. canes. wheelchairs. community linkage among hospital trauma centers.Do-Not-Resuscitate (DNR) Order placed on a patient’s chart by the attending physician. ambulance emergency units and other emergency vehicles. with a patient or surrogate consent that directs hospital personnel not to revive the patient if respiratory or cardiac activity ceases. Drug Formulary Durable Medical Equipment Services EMTALA EPSDT Emergency Medical System (EMS) Emergency Response System Glossary of Healthcare Terms & Abbreviations Page 11 . walkers and respirators. It can include. 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. The sale or rental of products and/or equipment designed to assist individuals needing medical care at home. Early Periodic Screening. personnel trained in emergency medicine.
Employee Retirement Income Security Act of 1974. Unit for treatment of inpatients who require convalescent. Its purpose may be to direct educational programs or provide forums for discussion of these issues among hospital medical professionals and others. tax-exempt organizations. Method of charging patients for services or treatment in which a provider bills for each patient encounter or treatment or service rendered. providing income for the continued support of a not-for-profit organization. Ethics Committee Exclusive Provider Organization (EPO) Extended Care Unit Fee For Service Financial Statement Fiscal Intermediary (FI) 501(c)(3) Glossary of Healthcare Terms & Abbreviations Page 12 . private insurance company. The section of the tax code that defines nonprofit. Blue Cross Plan. or other public or private agency selected by healthcare providers to pay claims under Medicare. rehabilitative or long-term skilled nursing care. assets and liabilities. A healthcare plan in which subscribers are eligible to receive benefits when they use the services of a limited network of providers. Detailed report of the financial conditions of an entity including profits. Hospital Committee concerned with biomedical ethics issues. losses. charitable. selfinsured companies are usually organized under ERISA and are exempt from state laws governing insurance. Currently Riverbend in Tennessee is the FI for New Jersey.Endowment ERISA Funds intended to be invested in perpetuity. to serve in an advisory capacity and/or as a resource to healthcare professionals involved in biomedical ethical implications.
An example is a freestanding ambulatory surgery center. resulting in a plan for comprehensive treatment and referral to appropriate providers reflecting individual and family preferences and financial status. Enforcement comes under several umbrellas of the government. An interdisciplinary service providing a comprehensive assessment of the physical and mental health. 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. 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. and the functional. Civil action in enforced by The Office of the Inspector General (OIG) and Department of Health and Human Services (DHHS). Healthcare facilities that are not physically. Violations can result in criminal and/or civil punishment. this has been deemed illegal by the OIG and DHSS. The Department of Justice (DOJ) enforces criminal penalties. Staff are usually trained in geriatrics. (see geriatric acute unit) Free-Standing Facilities Gainsharing Gatekeeper Geriatric Acute Care Unit Geriatric Assessment Service Glossary of Healthcare Terms & Abbreviations Page 13 . paying or receiving bribes or kickbacks for referrals and selfreferral schemes. A common description of a compensation agreement between hospitals and physicians. This law prohibits three things: filing false claims. 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. Geriatric assessment/rehabilitation units utilize a multidisciplinary team of therapists. An assessment service can be part of an inpatient or ambulatory care setting. administratively or financially connected to a hospital.Fraud and Abuse The federal body of law applying to Medicare and Medical providers. Under the current system of payments for Medicare. social and financial status of an older adult.
airflow control. commissioners or directors. The colloquial term used to describe the choice of a provider not to be protected by malpractice or professional liability insurance. staff model HMO and group model HMO) Geriatrician Going Bare Governing Body Hazardous materials (HAZMAT) Health Maintenance Organization (HMO) Glossary of Healthcare Terms & Abbreviations Page 14 . local government or stockholders. biological or chemical materials or agents. nurses. IPA. In the event of this type of emergency a hospital is required to control patient admissions through a special entrance. social workers and therapists. The legal entity ultimately responsible for hospital policy. which may be a corporation. the community. organization. Also called the governing board. Within a disaster preparedness plan there is often a hazardous material plan incorporated to deal specifically with this type of emergency. 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 governing body is accountable to the owner(s) of the hospital.Geriatric Assessment Team Disciplinary team of professionals that may have the following members: physicians. (see capitation. board of trustees. management. Materials that are harmful to humans and other living things like radioactive. and quality of care. special equipment for staff. Many hospitals prohibit this practice by requiring medical staff members to carry insurance. 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. The team assesses the medical and psychosocial needs and functional status of elderly patients to determine the services they require. decontamination.
It is an independent. increase self . Separate entity used to hold a variety of subsidiary groups that often perform related functions but have a distinct corporate identity. HealthPAC pools contributions from individuals to financially help support the campaigns of those who demonstrate their commitment to hospitals.) formed to educate New Jersey legislators and political candidates regarding issues affecting New Jersey’s hospitals. not affiliated with any political party.A.HealthPAC A political action committee (P. A program for providing nursing. A document on the Internet’s World Wide Web (WWW). NJHA meetings and other important information. Hill and Burton. meal preparation and grocery shopping. A federal program established in the 1960’s that created financial assistance for the construction and renovation of hospitals and other healthcare facilities.care skills. Health Promotion Services Hill-Burton Holding Company Home Healthcare Home Page Homemaker/Home Health Aide Glossary of Healthcare Terms & Abbreviations Page 15 . Education and/or other supportive services that are hospital planned and coordinated to help people to adopt healthy behaviors.C. as well as to NJHA member hospitals that have their own WWW home page. as well as personal care services. 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). links the Avisitor” to HRET educational programs. therapy and health-related homemaker or social services to individuals in their homes. The NJHA home page. use health care services effectively and increase understanding of medical procedures and therapeutic regimens. for example. Programs designed to prevent institutionalization and/or deterioration of an older adult by providing in-home suppor services such as light housekeeping. reduce health risks. bi-partisan organization. Named for its two principal congressional proponents.
Hospice Care Hospital Alliance Hospitalist House Staff Indigent Care Individual Practice Association Model Glossary of Healthcare Terms & Abbreviations Page 16 . uncompensated care) In an IPA. emotional. (see medically indigent. (see hospital alliance and vertical integration) Care that addresses the physical. both inpatient and at home and includes bereavement care for the family. A physician who specializes in inpatient medicine. 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.e. social. charity care. psychological. 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. The physiHMO (IPA) cians may own the HMO and are usually reimbursed on a fee-for-service basis. In the hospital setting. the hospitalist functions as a primary care physician does outside of the hospital coordinating care. Typically. Medical care for those who cannot afford it. the hospitals in an alliance retain their individual autonomy. independent doctors and/or small group practices contract with an HMO to provide services to an enrolled population.. spiritual. financial and legal needs of the person who is terminally ill and his or her family. A competitive strategy used by some hospitals to control the geographical distribution of healthcare services. This Apool” of funds held by the IPA=s administration can be redistributed to the doctors in a profitable year. a multi-organizational system composed of acute care hospitals. with a percentage withheld. but may share information and services and do joint planning and group purchasing.Horizontal Integration A linkage or network of the same types of providers i. Hospice care is provided by an interdisciplinary team of professionals and volunteers in a variety of settings.
or PGY I.medical school clinical training. Also called community care network. the American Hospital Association. Inpatient Insurance. III. IV or V. 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. 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. Nosocomial Infection acquired during hospitalization that is neither present nor incubating at the time of hospital admission. A patient receiving acute care through admission to the hospital for a stay of longer than 24 hours. 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. They are now more commonly called Post Graduate Year. Also referred to as a Aproprietary” hospital. II. Catastrophic Insurance. that may become clinically manifest after discharge from the hospital. An independent.Infection. Major Medical Integrated Delivery (IDS) Intern Intermediate Care Facility Investor-Owned Hospital Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Glossary of Healthcare Terms & Abbreviations Page 17 . A local or regional healthcare network that provides a full range of System services for all aspects of healthcare in a specific geographic area. not-for-profit accreditation body sponsored by the American College of Physicians. the American College of Surgeons. A term used to identify physicians in their first year or two of post. voluntary. or insurance in excess of specified amounts or other dollar or benefit limits. A facility that provides nursing. A hospital operated by a for-profit corporation in which the profits go to shareholders who own the corporation. the American Medical Association and the American Dental Association. The JCAHO conducts accreditation surveys for hospitals and other healthcare organizations.
A program through which older adults commit to reside in a community for the remainder of their lives.Joint Venture A cooperative financial relationship between two parties (i.e. cardiopulmonary resuscitation or other measures used if there is no hope of recovery. Length of Stay (LOS) Licensure Lifecare/Continuing Care Life Safety Code Living Will Glossary of Healthcare Terms & Abbreviations Page 18 . such as operation of a hospital. The fee guarantees residents a specified package of health and long-term care benefits (in addition to Medicare cover services). to ensure that the public health. 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. co-payment and deductibles. Formal process by which a government agency grants an individual the legal right to practice an occupation. A statement of a person’s preferences for medical treatment if he or she becomes incapable of making healthcare decisions.. two hospitals. Operation of some living wills is restricted until the patient is terminal. Persons who sign living wills also should make their wishes known to their family and physician. Number of calendar days that elapse between an inpatient’s admission and discharge. 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. Most living wills specify that the person does not want respirators. hospital and physician group. hospital and HMO) in which each party shares risks and benefits. grants an organization the legal right to engage in an activity. Also known as an Advanced Directive. safety and welfare are reasonably well protected. and prohibits all other individuals and organizations from legally doing so.
Long Term Care Acute Care Hospital (LTAC) Magnetic Resonance Imaging (MRI) Malpractice Market Basket Marketing Meals on Wheels Medicaid Medical Director Glossary of Healthcare Terms & Abbreviations Page 19 . services and promotional strategies to reach these markets. Previously known as nuclear magnetic resonance (NMR). this care is provided in a variety of settings. A joint federal-state program which since 1966 has paid much of the healthcare costs of certain (but not all) low-income persons. and responsible for medico-administrative affairs.Long-Term Care Those services designed to provide diagnostic. generally reporting to the CEO. Components of the overall cost of health care used to determine the Consumer Price Index (CPI). supportive and maintenance services for individuals (and their care givers) who have chronic physical and/or mental impairments. A systematic process for researching the needs and desires of consumers and customers and designing responsive programs. including the home. The federal government sets certain minimum rules and payment levels and provides some of the funding. rehabilitative. therapeutic. and each state administers the program. Failure in providing healthcare services to exercise the degree of skill and care generally exercised by like professionals under similar circumstances. Using a scanner. Either free standing or hospitals-within-hospitals. Physician who serves as a salaried chief of staff. 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. contributes additional funds and may establish additional eligibility rules and benefits. LTACs provide acute care services for patients requiring and average length of stay of at least 25 days. social and psychological functioning. The goal of a comprehensive long-term care system is to promote the optimal level of physical. preventive. 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.
by current income standards. is not poor but lacks the financial resources to afford necessary medical services. Established in 1990 by Congress. and may include other licensed individuals permitted by law and by the hospital to provide inpatient care services independently in the hospital. An insurance concept designed to give individuals greater control in the use of their healthcare dollars. Employers can draw from the account to cover their first dollar healthcare expenses. Medical Staff Organization Medically Indigent Medically Underserved Area Medicare Medicare Geographic Classification Review Board Glossary of Healthcare Terms & Abbreviations Page 20 . The funds used to create the account come from the savings realized by purchasing the high-deductible insurance plan.” These individuals together make up the “organized medical staff. Part B (medical insurance) pays for most physicians’ services. Geographic location that has insufficient health resources to meet the medical needs of the resident population. 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. Part A (hospital insurance) pays for most inpatient hospital care and some follow-up care. MSAs combine a highdeductible major medical insurance policy (which usually costs less than a low-deductible policy) with an employer-funded healthcare savings account. That body which. The federal health insurance program for people age 65 and over and those with certain chronic disabilities. Patients are responsible for deductibles and co-payments. this five-person board reviews hospital requests for geographic reclassification for Medicare prospective payment system purposes. according to the medical staff standard of the JCAHO. 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.Medical Education.” A person who. Medicare has two parts. Medicare pays hospitals for patient care using a prospective pricing system (PPS) based on diagnosis-related groups (DRGs). “includes fully licensed physicians.
In 1997 Congress approved the merger of The Physician Payment Review Commission and the Prospective Payment Assessment Commission to form MedPAC. lease. Multi-hospital systems may be vertically or horizontally integrated. Midwife.Medicare Supplemental Income Medicare Payment Advisory Commission (MedPAC) Private insurance policies that pay some or all of Medicare’s deductibles and copayments. This body provides policy advice and technical assistance concerning Medicare and other parts of the healthcare system. In New Jersey. The team often includes a physician. Certified Nurse Morbidity Multi-Hospital System Multi-Disciplinary Team National Health Insurance National Practitioner Data Bank Glossary of Healthcare Terms & Abbreviations Page 21 . psychiatrist or psychologist. (see Geriatric Assessment Team) Federal health insurance program designed to provide comprehensive benefits to the majority of the population. injury or disability in a defined population. contract management or vertical integration. It assists state licensing boards.J. An organizational affiliation among two or more healthcare organizations. An approach to caring for the elderly that involves a multidisciplinary team of professionals having the goal of providing comprehensive. It conducts independent research. 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. certified nurse midwives must have a masters degree in nursing and be certified by the N. nurse and social worker working closely together and. physical or other therapist. Information reported to the bank is confidential except to those legally allowed to access it. Extent of illness. An alert or flagging system created to facilitate a more comprehensive review of professional credentials. A registered professional nurse with post-graduate education in pre-natal care and the delivery of babies. may also include an occupational. depending on the patient’s needs. Board of Medical Examiners. The tie among the institutions can be through ownership. analyzes legislation and makes recommendations to Congress. integrated care.
the occurrence policy will cover the management and payment of the claim. Applications can provide images (pictures) for diagnostics and others provide diagnostic tests and treatments for disease. 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 Glossary of Healthcare Terms & Abbreviations Page 22 .Neonatal An infant’s life from the hour of birth through the first 27 days. It provides coverage for liability arising from malpractice that occurred while the policy was in effect.e. pediatrics. regardless of when the claim is filed/ reported/ made. if a claim is filed after an occurrence policy has expired.. Insurance coverage is provided for all events that occur while the policy is in force. The use of radioisotopes to diagnose and treat patients. For example. The inpatient census. 23 hours and 59 minutes (this constitutes the definition of newborn). A registered professional nurse with graduate level education in a nursing specialty (i. In N.J.. A financial plan for the expected revenues and expenditures of the day-to-day operations of the hospital. ORYX is an initiative of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). NPs are licensed by the State Board of Nursing and are qualified to carry out expanded healthcare evaluations and treatment plans. 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. Introduced in 1997. regardless of when the claim or potential loss is reported. but the claim alleges an act of malpractice that occurred when the policy was in force. family health. Also known as advanced practice nurse. gerontology).
access to treatment. waiting time. etc. III. Providers who use and pass OASIS measurements are Medicare-certified home health agencies. A CMS mandated program that is carried out by the Peer Review Organization (PRO) for each state. staff. The PRO in New Jersey is operated by The Peer Review Organization of New Jersey. Inc. or is in active labor or contractions once that person has been presented at a hospital emergency room or emergency department. Post Graduate Year I. residents) A technician with 18 months training in emergency medicine.Outcome and Assessment Information Set (OASIS) Outlier Outpatient PGY I. II. IV. II. IV and V. III. V CMS developed a data set for use in monitoring outcomes of adult home health care patients.e. a term used to identify a medical school graduate’s year of post-graduate clinical training. A patient that generates unusually high costs or requires an unusually long stay. Paramedic Patient Dumping Patient Satisfaction Survey Payment Error Prevention (PEPP) Peer Review Organization (PRO) Glossary of Healthcare Terms & Abbreviations Page 23 . The objective of PEPP is to reduce payment errors made under the prospective payment system (PPS).. treat and stabilize any person irrespective of payer/class who has an emergency medical condition. food. i.) (see interns. (Previously known as interns and residents. Paramedics administer emergency care out of the hospital. A person who receives care without being admitted to the hospital for overnight or longer stay. 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 refusal to examine. (see EMTALA) A questionnaire use to solicit the perceptions of patients regarding their stay and/or service in a healthcare facility.
usually for the purpose of obtaining managed care contracts directly with employers. services covered and payment. board and the provision of some assistance with activities of daily living (i. This system is especially effective in evaluating brain and nervous system disorders. Physician Assistants must complete an accredited education program and be licensed by a recognized agency or commission. A type of managed care plan in which beneficiaries have the option of choosing to obtain medical services from the provider of their choice. In New Jersey PAs are licensed by the N.e. Board of Medical Examiners.Performance Measurement System A clinical outcome measurement model developed in 1993 by NJHA and QuadraMed Corp. Room. bathing. Also available in an electronic version that can target specific results down to individual physician practice patterns or patient profile analysis. Person who provides healthcare services (customarily performed by a physician) under responsible supervision of a qualified licensed physician. An imaging technique that tracks metabolism and responses to therapy used in oncology. grooming. or a primary physician from the plan’s panel of physicians.J.. The PHO serves as a collective negotiating and contracting unit. They are provided to retirees through the employer’s group health plan and the set of benefits varies according to eligibility. The system provides hard-copy reports providing comparisons to peer groups and riskadjusted predicted rates based on actual patient data. Personal Care Physician Assistant (PA) Physician-Hospital Organization (PHO) Point Of Service (POS) Positron Emission Tomography (PET) Post Retirement Health Benefits (PRHBs) Glossary of Healthcare Terms & Abbreviations Page 24 . A major component of general retirement benefits that cover healthcare cost not paid by Medicare (in part or fully). There is a financial incentive to select a primary physician from the plan’s panel. eating). A legal entity formed by a hospital and a group of physicians. neurology and cardiology.
there is a financial incentive to use participating providers. A hospital’s product line might be as broad as cardiac care or surgical care. A statistical summary of population-specific healthcare data used to assess healthcare delivery. The relationship between service input and output.Point-Of-Service Plan A type of health plan allowing the covered person to choose a service from a participating or non-participating provider. or as specific as care by DRG or product code. including hospitalization and specialist referrals. Groupings of related business activities. The state of being able to continue health insurance coverage when changing job or residence. Assuring the organizational processes meet quality. insurance carriers or third-party payers to provide healthcare services to a defined population. cost and productivity processes means they can be defined. Population Profile Portability Preferred Provider Organization (PPO) Primary Care Physician Private Not-For-Profit Process Management Product Line Productivity Glossary of Healthcare Terms & Abbreviations Page 25 . Typical productivity measures for labor cost include full-time equivalent positions (FTE) per patient day. They are sometimes referred to as “voluntary” hospitals. measures and systematically proved. FTEs per admission and FTEs per bed. 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. In managed care the term refers to the physician responsible for coordinating and managing the healthcare needs of members. PPOs are organizational entities that have a contractual arrangement between healthcare providers (including institutions and professionals) and employers. without a waiting period or having to meet additional deductible requirements.
The process used to determine the quality of care. per capita. 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 Assessment Commission (ProPAC) Prospective Payment Pricing) System (PPS) Provider Provider . the law that created Medicare’s DRG-based prospective payment system (PPS). An independent commission established by the Social Security Amendments of 1983 (Public Law 98-21). typically managerial or professional members. Healthcare systems owned and operated by providers that integrate a wide spectrum of services and contract with various entities on a managed care basis.e. Also known as a Provider Sponsored Network (PSN). to advise the Secretary of Health and Human Services on the annual update factor and on adjustments of DRG classifications and weights. or by which hospitals are paid a fixed. Glossary of Healthcare Terms & Abbreviations Page 26 . such as a physician or nurse. A hospital or healthcare professional who provides healthcare services to patients. to develop and maintain programs to keep it at an acceptable level and to correct patterns of care that fall below that level. nursing home or other) or a person.Professional Liability Insurance Prospective Payment Protection for real or alleged errors committed in the practice of a profession (i. Hospital Professional Liability). per diem or per case rates.Sponsored Organization (PSO) Quality Assurance Quality Improvement System Quality Improvement Team Usually an ad hoc team from multiple departments. prospectively set price for each Medicare beneficiary treated as an inpatient according to the patient’s DRG. Prospective payment rates may be per service. May be an entity (hospital. System that strives to prevent crises rather than manage them. whose purpose is to improve quality in a specific area. Medicare’s system. adopted in the Social Security Amendments of 1983.
Physicians’ fee limitations determined on the basis of the lowest of actual charge.Quality of Care RFP The degree to which patient care meets accepted principles and standards of practice. called Areinsurers. social. Request for Proposal.6). Prospective review by a government or private agency of a hospital’s budget and financial data. A type of insurance purchased by primary insurers (insurers that provide healthcare coverage directly to policy holders) from other secondary insurers. and/or vocational services to disabled persons to help them attain their maximum functional capacity. 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. health-related. An RFP lists project specifications and application procedures for contracts or grant programs. performed for the purpose of determining the reasonableness of the hospital rates and evaluating proposed rate increases. RFPs are sent to organizations that might be qualified to participate in the grant program. state and federal agencies. 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.” to protect against part of all losses the primary insurer might assume in honoring claims of its policyholders. Used most frequently by local. Rate Review Reasonable Charges Regulated Medical Waste Rehabilitation Facility Reinsurance Glossary of Healthcare Terms & Abbreviations Page 27 . 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.
level of skill and sophistication of equipment required to render service. Formerly. The regulations specify certain types of provider payment arrangements that are not subject to criminal prosecution or civil sanctions. the first year after graduation was referred to as an “internship” and thereafter. A set of federal regulations which clarify and ease the restrictions of the Medicare/Medicaid Fraud & Abuse Statutes. III.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. IV and V) Patient care provided intermittently in the home or institution in order to provide temporary relief to the family home care giver. Resident Respite Care Restricted Funds Risk Management Safe Harbor Regulations Same Day Surgery Glossary of Healthcare Terms & Abbreviations Page 28 . as “residency. control and funding. A resident is a graduate physician in post-graduate hospital clinical training. II. 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. Services provided are more intensive in nature than those commonly provided by adult day care programs.” The years are now referred to as post-graduate years (PGY) I V. A hospital-based program that provides intensive medical. (see PGY I. 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. and also includes the management of workers compensation and claims professionals.
containing cost and/or effecting economies of scale. Rather. capable of holding an individual’s complete medical history and other healthcare information. A volunteer program making particular efforts to recruit and involve older adults. Administrative. 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. clinical or service functions that are common to two or more healthcare institutions. the hospital pays its malpractice losses and related expenses from its operating capital. which are used jointly or cooperatively by them in some manner for the purpose of improving service. they contain a small semiconductor chip. The care may be delivered in a freestanding facility or in a unit of a hospital. Subscribers choose a primary care physician from the physicians employed by the HMO. To be reimbursed by Medicare.” Under this method the hospital makes no prearrangement whatsoever to cover the payment of malpractice liability losses or litigation or claims management costs. Credit-card-sized. Nursing or other rehabilitative services provided under the direction of a physician or an approved professional.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. Senior Volunteer Program Shared Services Skilled Nursing Care Skilled Nursing Facility (SNF) Smart Card Staff Model HMO Glossary of Healthcare Terms & Abbreviations Page 29 . rehabilitative and/or restorative services. Physicians are employed to provide services to subscribers at the HMO’s corporate location or its multiple satellite locations. Another form of self-insurance is non-funded self-insurance. or “going bare.
the Legislature revised the statutes in 1992 to make the State Health Plan only an advisory document. Although the State Health Plan was originally given the force and effect of law. Financial report showing liquid assets increasing and decreasing (balance of cash accounts). Required by the Health Care Cost Reduction Act of 1991. Also known as excess risk insurance. excess or unexpected expenses. the State Health Plan is a document. and to serve as the basis on which all certificate of need applications will be reviewed and approved.Staffing Ratio State Health Plan The total number of hospital employees (full-time equivalents. The Board is responsible for annually preparing and revising the State Health Plan. An insurance policy designed to reimburse a self-funded arrangement of one or more small employers for catastrophic. A hospital that has an accredited medical residency training programs and is often affiliated with a medical school. 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. prepared by the State Health Planning Board and the Department of Health. the State Health Planning Board serves as the planning advisory board to the Department of Health. that is intended to identify unmet health needs in an area by service and location. A health care facility separated physically from a hospital that provides prescheduled outpatient surgical services. neither the employees nor other individuals are third-party beneficiaries under the policy. State Health Planning Board Statement of Change in Fund Balance Stop Loss Insurance Subacute Care Surgicenter Swing Beds Teaching Hospital Glossary of Healthcare Terms & Abbreviations Page 30 . or FTEs) divided by the average daily census. Established by the Health Care Cost Reduction Act of 1991. Unused acute care beds that can be “swung” to long-term care beds within the same hospital.
A video teleconference allows visual communication between participants while an audio teleconference is limited to voice communications. The healthcare provider is paid for services rendered at essentially a rate equivalent to usual and customary fees.TEFRA In 1982. A payer that neither gives nor receives the care (the patient and the provider are the first two parties). A fixed premium for a year through which the subscribers receive medical care from their chosen provider.related groups. Teleconference Tertiary Care Third-Party Payer Tort Total Quality Management (TQM) Traditional Insurance Glossary of Healthcare Terms & Abbreviations Page 31 . This law limited the amount of all hospital inpatient costs per discharge and mandated the development of a prospective pricing system (PPS). Medical care of a highly technological and specialized nature provided in a medical center or teaching and research institution for patients with severe. 97-248. Tax Equity and Fiscal Responsibility Act. There are 467 DRGs and the government reimburses the hospital a flat rate for each DRG and considers that rate as payment in full. hence the term prospective pricing. A civil remedy to a negligent or intentional civil wrong excluding a breach of contract. Usually an insurance company or government agency.L. The rate for each DRG is established before the patient is treated. A meeting held at two or more different locations where participants are able to communicate with each other in real time using telecommunications. complicated or unusual medical problems. Congress passed P. or DRG. 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. The PPS reimbursement diagnosis .
unlicensed staff who assist professional staff in the delivery of patient care. A HCFA initiative that involves collection of approximately 1. A hospital.J. (see charity care) Uniform billing form submitted to the N. clinical history. Any funds not designated for a specific purpose. The traditional method of determining the prevailing physician fees in a given area. Uniform Bill . Sometimes referred to as a “minor emergency facility” or “urgicenter.UB-92 Uniform Clinical Data Set (UCDS) Unlicensed Assistive Personnel (UAP) Unrestricted Funds Urgent Care Center Usual. Care for which the provider is not compensated. that is equipped and staffed to receive critically ill or injured patients.800 data elements that describe patient demographic characteristics. uncompensated care includes charity care and bad debts (uncollectible charges to patients who have the ability to pay). a physician or a corporate entity may sponsor it. specifically designated within a region. A system of assigning priorities of medical treatment on the basis of urgency. Every acute care hospital in the state submits this data for all inpatients and all same-day surgery patients. The data is obtained from the medical records of Medicare beneficiaries Trained. Department of Health and Senior Services. clinical findings and therapeutic intervention. A high frequency (pitch above human hearing) imaging technique also called sonography.Trauma Center Triage Ultrasound Uncompensated Care A hospital. Generally.” it is a free-standing emergency care facility. Customary & Reasonable Charges (UCR) Glossary of Healthcare Terms & Abbreviations Page 32 . chance for survival or other indicators.
Some third-party payers have external utilization review organizations to review services. home and hospice care. joint ventures and contractual arrangements. JCAHO.Utilization Review A systematic program of reviewing and managing patient care in pursuit of cost-effective use of hospital services including patient days. long-term. medications and surgical procedures. (see multi-institutional system. Medicare and other external bodies require hospital utilization management programs. A healthcare system that provides a range of continuum of care such as outpatient. horizontal organization and integrated delivery system) Vertical Integration Glossary of Healthcare Terms & Abbreviations Page 33 . acute hospital. usually through partnerships. diagnostic tests.
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 Glossary of Healthcare Terms & Abbreviations Page 34 .
prevailing and reasonable (charges) Certified Registered Nurse Anesthetist Glossary of Healthcare Terms & Abbreviations Page 35 .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.
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 Glossary of Healthcare Terms & Abbreviations 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) Glossary of Healthcare Terms & Abbreviations Page 37 .
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 Glossary of Healthcare Terms & Abbreviations Page 38 .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.
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 Glossary of Healthcare Terms & Abbreviations 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 Glossary of Healthcare Terms & Abbreviations 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 Children’s 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 Glossary of Healthcare Terms & Abbreviations Page 41 .
modified in 1992 Uniform bill patient summary Usual.UAP UP-92 UBPS UCR UMDNJ UR URL VA VHA WC WWW YTD Unlicensed assistive personnel Uniform Billing form. customary and reasonable charges University of Medicine and Dentistry of New Jersey Utilization review Uniform Resouce Locator Veterans Administration Voluntary Hospitals of America Worker’s compensation World Wide Web Year-to-date Glossary of Healthcare Terms & Abbreviations Page 42 .
760 Alexander Road PO Box 1 Princeton.njha.com . NJ 08543-0001 609-275-4044 www.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.