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Health Care Admin

QuestionAnswer
Material Safety Data Sheet (MSDS) The document provided by chemical or industrial manufacturers that contains information on hazardous chemicals.
National Library of Medicine (NLM) World's largest medical library.
Negligence Failure to perform duties or activities with due diligence and attention or to meet the standards of regular care.
Outcomes Management Use of information collected through measurement of outcomes to improve effectiveness and value of treatments and services.
Peer Review Assessment of research proposals, manuscripts submitted for publication, or a physician's clinical practice by other physicians or scientists in the same field.
Population Statistical term denoting all the objects, events, or subjects in a particular class.
Practice Direct professional involvement in health care services.
Practice Guidelines Recommendations developed by groups of clinicians for delivery of care based on various indications.
Principal diagnosis The diagnosis that is found, after testing and study, to be the main reason for the patient's need for health care services.
Public Health The art and science of community health, an effort organized by society to promote, protect, and restore the people's health; public health is a social institution, a service, and a practice.
Sequela A condition following as a consequence of a disease.
Capitation A system of medical reimbursement wherein the provider is paid an annual fee per covered patient by an insurer or other financial source; the aggregate fees are intended to reimburse all provided services.
Coinsurance The amount or percentage the insured is responsible for after the deductible has been met.
Coordination of Benefits A clause in insurance policies for patients with more than one carrier to provide a maximum of 100% benefits. One carrier is designated as primary carrier; a second carrier covers any remaining costs not covered by the primary carrier.
Co payment A fixed or set amount paid for each health care or medical service; the remainder is paid by the health insurance plan. In common parlance, copay is the term used.
Deductible The amount for which the insured is responsible before the health care plan pays; amount usually set on an annual basis.
Episode of Care All services provided to a patient with a medical problem within a specific period of time across a continuum of care in an integrated system.
Evidence-based Medicine The process of applying relevant information derived from peer-reviewed medical literature to address a specific clinical problem; the application of simple rules of science and common sense to determine the validity of the information
Exclusive Provider Organization (EPO) A managed care plan in the U.S. in which enrollees must receive their care from affiliated providers; treatment provided outside the approved network must be paid for by the patients.
Group Practice The cooperative practice of medicine by a group of physicians, each of whom as a rule specializes in some particular field; such a group often shares a common suite of consulting rooms, laboratories, staff, equipment, etc.
Health Care Provider General term for any institution or member of the health care team providing health care.
Health Care System Organized system of providers and services for health care; may include hospitals, clinics, home care, long-term care facilities, assisted living, physicians, health plans, and other services.
Health Information System Combination of vital and health statistical data from multiple sources, used to derive information about the health needs, health resources, use of health services, and outcomes of use by the people in a defined region or jurisdiction.
Health Insurance A commercial product designed to protect U.S. consumers from the financial risks of illness and injury.
Health Maintenance Organization (HMO) A comprehensive prepaid system of health care; generally offers a package of services; however, the choice of physician is frequently limited to those participating in the HMO.
Group Model HMO An HMO that contracts with a single medical practice to be the sole source of care for its patients; two types of practice: “captive” group- formed by an HMO to serve its subscribers;“independent” group- independent practice that contracts with the HMO.
Inpatient Patient who is admitted to and is assigned a bed in a health care facility while undergoing diagnosis and receiving treatment and care.
Insurance A contractual arrangement whereby one party agrees to indemnify the other against financial or other specified loss during a stated period in the future.
Managed Care An arrangement in the U.S. whereby a third-party payer (insurance company, government, or corporation) mediates between physicians and patients, negotiating fees for service and overseeing the types of treatment given.
Medicaid A nationwide health insurance program in the U.S. that provides coverage to certain low-income citizens and qualified legal residents; funded jointly by the state and federal governments
Medicare A national health insurance plan managed by the U.S. government that covers Social Security and Railroad Retirement beneficiaries age 65 years and older,
Medicare Part A The portion of the U.S. Medicare Program that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Medicare Part B The portion of the U.S. Medicare Program that helps pay for physician services, outpatient hospital care, durable medical equipment, and some services not covered by Medicare Part A.
Medigap Insurance A supplemental insurance policy designed to fill the “gap,” that is, any care or services not covered under the Medicare program.
National Provider Identifier (NPI) A standard and unique identification number created by the U.S. HHS for each provider of health care services, supplies, and equipment.
Precertification Verification of a procedure as a covered benefit for a third-party payer before a health care service is performed. It does not guarantee coverage.
Preferred Provider Organization (PPO) A U.S. health care organization that negotiates set rates of reimbursement with participating health care providers for services to insured clients. This is a type of prospective payment system.
Primary Care Physician A physician in family practice, internal medicine, obstetrics/gynecology, or pediatrics who is a patient's first contact for health care in an ambulatory setting.
Workers Compensation
Created by: cwaite1