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Chapter 3

Health Information Management Terms

TermDefinition
Accountable Health Plan Integrated Delivery System (IDS) Integrated Service Network Delivery System Vertically Integrated Plan Vertically Integrated System Horizontally Integrated System Health Delivery Network Organization of affiliated provider sites that offer joint health care services to providers. Sites include: *Ambulatory surgical centers *Hospitals *Physician groups *and so on.
Activity of Daily Living (ADL) Bathing, dressing, eating, toileting, walking, and so on.
Acute Care Facility (ACF) Hospital that provides health care services to patients who have serious, sudden, or acute illnesses or injuries and/or who need certain surgeries.
Acute Hospital Classification Short-term Hospital Classification Patients have an average LOS of 4-5 days and a total LOS of less than 25 days.
Administration for Children and Families (ACF) DHHS programs that provide services and assistance to needy children and families; including Temporary Assistance to Needy Families (TANF).
Administration on Aging (AoA) DHHS program that supports a nationwide aging network, providing services to the elderly to enable them to remain independent.
Adult Day Care Provides care and supervision in a structured environment to seniors with physical or mental limitations
Agency for Toxic Substances and Disease Registry (ATSDR) DHHS agency that works with states and other federal agencies to prevent exposure to hazardous substances from waste sites.
Alzheimer's Treatment Facilities Long-term care facility that specializes in the care of patients diagnosed with Alzheimer's disease.
Ambulatory Care Outpatient Care Outpatient care that allows patients to receive care in one day without the need for inpatient hospitalization.
Ambulatory Infusion Center (AIC) Infusion Center Freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients. Infusion is supervised by a licensed health care professional.
Ambulatory Patients Outpatients Patients who are treated and released the same day and do not stay overnight in the hospital; length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds.
Ambulatory Surgery Patient Certain procedures can be performed on an outpatient basis, with the patient treated & released the same day. Length of stay is a maximum of 23 hrs, 59 min, & 59 secs; if patients require a longer stay, they must be admitted to the facility as inpatients.
Ambulatory Surgical Center (ASC) Surgery is performed on an outpatient basis at a free-standing ambulatory surgical center. patients arrive on the day of the procedure, undergo surgery in an operating room, and recover under the care of nursing staff.
Ancillary Services Diagnostic and therapeutic services provided to inpatients and outpatients.
Assisted-Living Facility (ALF) Combination of housing and supportive services including personal care and household management for seniors. Residents pay monthly rent and additional fees for services they require.
Bed Count Bed Size Total # of inpatient beds for which the facility is licensed by the state.
Behavioral Health Care Hospital Specializes in treating individuals with mental health diagnosis.
Bureau of Prisons (BOP) Federal program that provides necessary medical, dental, and mental health services to inmates by a professional staff and consistent with acceptable community standards. It consists of 82 institutions, each of which provides inmate ambulatory care.
Cafeteria Plan Triple Option Plan Provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan.
Capitation Payment Lump sum paid by the HMO to the provider to care for a group of subscribers.
Centers for Disease Control and Prevention(CDC) DHHS agency that provides a system of health surveillance to monitor and prevent the outbreak of diseases.
Chemical Dependency Program Provides 24 hour medically direct evaluation and withdrawal management in an acute care inpatient setting. Treatment services usually include detoxification and withdrawal management, chemical dependency/substance abuse assessment, and therapy.
Chemotherapy Intravenous administration of chemical agents that have specific and toxic effects upon a disease-causing cell or organism.
Clinic Outpatient Hospital ambulatory care patient who receives scheduled diagnostic and therapeutic care.
Clinical Laboratory Performs testing in microbiology, clinical chemistry, and toxicology; directed by a pathologist; and testing is performed by certified, professional technologists and technicians.
Closed-Panel HMO Includes group and staff models that provide services at HMO-owned health centers or satellite clinics, or by physicians who belong to a specially formed medical group that serves the HMO.
Continuing Care Retirement Community (CCRC) Provides different levels of care based on the residents' needs from independent living apartments to skilled nursing care in an affiliated nursing facility.
Copayment Fixed amount a subscriber must pay when seeking health care services.
Correctional Facility Provides inmates with a secure housing environment that also offers vocational and educational advancement. Medical, dental, & mental health care services are provided to inmates according to a standard of care imposed by court decisions, legislation, acc
Crisis Service Provides short-term (usually fewer than 15 days) crisis intervention and treatment; patients receive 24-hour-per-day supervision.
Critical Access Hospital (CAH) Located more than 35 miles from any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents.
Curative Care Therapeutic
Day Treatment Program Intensive treatment program provided to patientswho live in the community but come to the facility up to 5 days a week.
Dementia Care Facilities Long-term care facilities that specialize in the care of patients diagnosed with dementia.
Developmentally Disabled/Mentally Retarded Facilities Sometimes catagorized as an intermediate care facility (ICF) these facilities provide residental care and day programming, including academic training, clinical and technical assistance, health care services, and diagnosis and evaluation of individuals wi
Diagnosis-related Groups Inpatient hospital cases classified into groups that are expected to consume similar hospital resources. Hospital inpatients are discahrged once the acute phase of illness has passed, and they are often transferred to other types of health car, such as ou
Direct Contract Model HMO Individual physicians in the community deliver contracted health care services to subscribers.
Drug Therapy Intravenous administration of other drugs including anitbiotics, antivirals, and so on.
Durable Medical Equipment (DME) Includes canes, cruthes, IV supplies, hospital beds, ostomy supplies, oxygen, protheses, walkers, wheelchairs, and so on.
Emergency Care Center Urgent Care Center Immediate care is provided by and on-duty physician (usually salaried). The center is usually owned by private corporations in states where permitted or non-profit facilities.
Emergency Care Patient One treated for urgent problems and either released the same day or admitted to the hospital as inpatient.
Exclusive Provider Oragnization (EPO) Provides benefits to subsvribers who receive health care services from network providers.
Family Practitioner Provides care for the entire family and focuses on general medicine, obstetrics, pediatrics. and geriatrics.
Family Support Services Services provided to assist families in caring for the patient.
Federal Certification Measures ability of health care facilities to deliver care that is safe and adequate, in accordance with federal law and regulation.
Federal Medical Centers (FMCs) Provide major medical care to federal correctional facility inmates.
Flexible Benefit Plan Triple Option Plan Provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan.
Food and Drug Administration (FDA) DHHS agency that assures tha safety of foods and cosmetics, and the safety and efficacy of pharmaceuticals, biological products, and medical devices.
General Hospitals Provide emergency care, perform general surgery, and admit patients for a range of problems from fractures to heart disease, based on licensing by the state.
Group Model HMO Participating physicians who are members of an independent multispecialty group providing health care services. Physician groups either contract with ther HMO or they are owned or managed by the HMO.
Group Practice Without Walls (GPWW) Managed care contract in which Physicians maintain their own offices and share services to plan members.
Health Maintenance Organization (HMO) An alternative to traditional health insurance coverage; provides comprehensive health care services to members on a prepaid basis.
Human Resource and Services Administration (HRSA) DHHS agency that provides health resources for medically undeserved populations, works hard to build the health care workforce, maintains the National Health Service Corps, oversees the nation's organ transplantation system, works to decrease infant morta
Heart and Vascular Center Provides ambulatory cardiovascular services to include diagnosis and treatment, disease prevention, research, education, and cardiac rehabilitation.
Home Care Allows people who are seriously ill or dying to remain at home and receive treatment from nurses, social workers, therapists, and other licensed health care professionals who provide skilled care in the home.
Home Infusion Care Provided by home health care agencies when intravenous administration of mediction is medically appropriate for the patients condition, and treatment is administered in the home instead of on an inpatient hospital basis.
Hospice Care Provides comprehensive medical and supportive socail, emotional, and spiritual care to terminally ill patients and their families. Goal is palliative rather than curative.
Hospitalist Physician who sepnds most of his or her time in a hospital setting admitting patients to inpatient services from local primary care providers.
Hospital-Owned Physician Practice Practices that are at least partially owned by the hospital, and physicians participate in a compensation plan provided by the hospital.
Hydration Therapy Intravenous administration of fluids, electrolytes, and other additives.
Imaging Center Freestanding facility that provides radioraphic and other imaging services to ambulatory patients. Some centers also provide training and participate in national research projects.
Indepedent Practice Association (IPA) Individual Practice Association (IPA) Physicians who remain in their independent office settings but provide contracted health care services to subscribers. Negotiates the HMO contract and manages the capitation payment.
Indian Health Services (IHS) DHHS agency that supports a network of 37 hosptials, 60 health centers, 3 school health centers, 46health stations, &34urban Indian health centers to provide services to nearly 1.5million American Indians &Alaska Natives of 557federally recognized tribes.
Industrial Health Clinic Located in a business setting, the emphasis is on employee health and safety.
Inpatients Those who remain overnight in the facility for 24 or more hours and are provided with room and board and nursing services.
Integrated Provider Organization (IPO) Manages health care services provided by hospitals, physicians, and other health care organizations.
Intensive Case Management Specially trained individuals coordinate and/or provide mental health, financial, legal, and medical services to help the patient live successfully at home and in the community.
Intermediate Care Facility (ICF) Provides developmentally disabled people with medical care and supervision, nursing services, occupational and physical therapies, activity programs, educational and recreational services, and psychological services.
Internal Medicine Physician Specializes in the care of adults.
Long-Term Care Includes a range of nursing, social, and rehabilitative services for people who need ongoing assistance. Lengths of stay typically average greater than 30 days.
Long-Term Care Hospital (LLTCH) Long-Term Hospital Classification Defined in Medicare law as hospitals that have an average inpatient length of stay greater than 25days. These hospitals typically provide extended medical &rehabilitative care for patients who are clinically complex &may suffer from multiple acute or chro
Originally referred to the prepaid health care sector, such as HMOs, which combined health care delivery with the financing of health care services; increasing used to refer to preferred provider organizations (PPOs) and some forms of indemnity coverage t
Management Service Organization (MSO) Provides practice management services, including administrative and support services, to individual physician practices.
Medical Foundation Nonprofit organization that contracts with and acquires the clinical and business assets of physician practices.
Medical Necessity Requires documentation of services or supplies that are proper and needed for the diagnosis or treatment of a medical condition; are provided for the diagnosis, direct care, and treatment of a medical condition; meet the standards of good medical practice
Military Health System (MHS) Administers health care for active members of the uniformed services (and their dependents) as provided by military treatment facilities and networks of civilian health care professionals.
Military Medical Support Office (MMSO) Coordinates civilian health care services when military treatment facility (MTF) services are unavailable.
Military Treatment Facility (MTF) Clinic and/or hospital located on US military base.
Multi-hospital Systems Category of hospitals where two or more hospitals are owned, managed, or leased by a single organization; these may include acute, long-term, pediatric, rehabilitation, and/or psychiatric care facilities.
Multispecialty Group Physician Practices Offers various types of medical specialty care in one organization, and they may be located in more than one location.
National Commission on Correctional Health Care (NCCHC) Provides an external peer review process for correctional institutions that wish to meet its nationally accepted Standards for Health Services.
National Institutes of Health (NIH) DHHS research center, with 17 separate institutes, is the world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's disease, diabetes, arthritis, heart ailments, and AIDS.
Neighbor Health Center Health care is provided to economically disadvantaged people, and treatment is family-centered because illnesses may result indirectly from crowded living conditions, unsanitary facilities, and other socioeconomic factors. Family care team consisting of a
Network Model HMO Two or more physician multispecialty group practices provide contracted health care services to subscribers.
Newborn Patients Those who receive infant care upon birth, and if necessary they receive neonatal intensive care either within the hospital or as a result of transfer to another hospital.
Nursing Facility (NF) Skilled Nursing Facility (SNF) Provides medically necessary care to inpatients on a daily basis that is performed by, or under the supervision of, skilled medical personnel. SNFs provide IV therapy, rehabilitation, and wound care services.
Observation Patients Receive services furnished on a hospital's premises that are ordered by a physician or other authorized individual, including use of a bed and periodic monitoring by nursing or other staff, which are reasonable and necessary to evaluate an outpatient's co
Office of Public Health and Science (OPHS) Directed by the Assistant Secretary for Health, serves as focal point of leadership and coordination across DHHS in public health and science, provides direction to program offices with OPHS, and provides advice and counsel on public health and science is
Open-panel HMO Includes direct contract, individual practice association, and network models; physicians are not employees of the HMO and they do not belong to a specially formed medical group that serves the HMO.
Pain Management Intravenous administration administration of narcotics and other drugs designed to relieve pain.
Pain Management Center Specializes in treatment of acute and chronic pain syndromes using proven medications and procedures. Usually a multidisciplinary approach is used, involving participating specialists such as physiatrists, psychiatrists, neurologists, neurosurgeons, inter
Palliative Care Comfort Management
Partial Hospitalization Program Program for hospital patients who regularly use the hospital facilities for a substantial number of either daytime or night time hours.
pediatrician Provides comprehensive services for infants, children, and adolescents.
personal care and support services Provide assistance in performing daily living activities such as bathing, dressing, grooming, going to the toilet, mealtime assistance, travel training, and accessing recreation services.
Physician-hospital organization (PHO) Managed care contracts are negotiated by hospital(s) and physician groups; physicians maintain their own practices and provide services to plan members.
Point-of-Service Plan (POS) Patients have the freedom to use an HMO panel of providers (for which a copayment is paid) or to self-refer to non-HMO providers (for which greater out-of-pocket expenses apply).
Preadmission Certification (PAC) Form of utilization management that involves the review for medical necessity of inpatient care prior to inpatient admission.
Preferred Provider Organization (PPO) Network of physician and hospitals join together to contract with third-party payers, employers, and other organizations to provide health care to subscribers for a discounted fee.
Primary Care Center Offers adult and family care medicine in internal medicine, pediatrics, and family practice.
Public Health Department Provides preventative medicine services such as well baby clinics, which include immunizations and routine checkups.
Public Health Service (PHS) Uniformed Service of the Department of Health and Human Services. Leadership is provided by the U.S. Surgeon General. It provides highly trained and mobile health professionals who carry out programs to promote the nation's health, understand and prevent
Referred Outpatient Hospital ambulatory care patient who receives diagnostic or therapeutic care because such care is unavailable in the primary care provider's office. Follow-up is done at the primary care provider's office.
Rehabilitation Hospital Admits patients who are diagnosed with trauma or disease and who need to learn how to function.
Residential Care Facility (RCF) Provides non-medical custodial care, which can be provided in a single family residence, a retirement residence, or in any appropriate care facility including a nursing home.
Residential Treatment Facility Seriously disturbed patients receive intensive and comprehensive psychiatric treatment on a long-term basis.
Respite Care Care provided by specially trained individuals at a setting other than the patient's home to offer relief and rest to primary caregivers.
Satellite Clinics Ambulatory care centers established remotely from the hospital. Primary care is provided by an on-duty physician (usually salaried)
Single Hospitals Category of Hospitals that are self-contained and not part of a larger organization.
Single-specialty Group Physician Practices Single-specialty practices that consist of two or more physicians who provide patients with one specific type of care.
Skilled Care Includes services that are ordered by a physician and not provided under the supervision of a registered nurse, or physical, occupational, or speech therapist.
Skilled nursing facility (SNF) Provides Medically Necessary care to inpatients on a daily basis that is performed by, or under the supervision of, skilled medical personnel. SNFs provide IV therapy, rehabilitation, and wound care services.
Solo Physician Practices Organizations that do not have physician partners or employment affiliations with other practice organizations.
Specialty Hospital Concentrates on a particular population of patients or disease.
Staff Model Health Maintenance Organization (HMO) Similar to large, multispecialty group practices, it may be partially owned by the physician employees, with the physicians typically functioning as employees of either the physician group owning the practice or the insurer. Most physicians in this type o
`Student Health Center Provides health care to full- and part-time students who become ill or injured.
Subacute Care Provided in hospitals that provide specialized long-term acute care such as chemotherapy, injury rehabilitation, ventilator support, wound care, and other types of health care services provided to seriously ill patients.
Subscribers Individuals who pay health insurance premiums.
Substance Abuse and Mental Health Services Administration (SAMHSA) DHHS agency that works to improve the quality and availability of substance abuse prevention, addiction treatment, and mental health services.
Swing Bed Allows a rural hospital to admit a nonacute care patient.
Temporary Assistance to Needy Families (TANF) State-Federal welfare program.
Therapeutic group Home 6 to 10 individuals are provided with supervised housing that may be linked with a day treatment program
Total Parenteral Nutrition (TPN) Administration of nutritional substances by peripheral or central intravenous infusion to patients who are either already malnourished or have the potential for developing malnutrition
Triple Option Plan Provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance.
Urgent Care Center Immediate care is provided by an on-duty physician (usually salaried). The center is usually owned by private corporations in states where permitted or non-profit facilities.
Utilization Management Controls health care costs and the quality of health care by reviewing cases for appropriateness and medical necessity.
Ventilator Breathing Machine.
Veterans Health Administration (VHA) An agency in the Department of Veterans Affairs that provides medical, surgical, and rehabilitative care to veterans of the armed services.
Created by: mross2284