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Glossary of Health Care Terms

Glossary Acronyms

The glossary provides a brief, easy-to-use and easy-to-understand list of health care and legislative terms that can help those in health care, as well as the community at large, better comprehend the evolving health care delivery system.

The glossary is organized alphabetically.

A comprehensive list of acronyms is also available to help sort through the health care alphabet soup.

a b c d e f g h i j k l m n
o p q r s t u v w x y z
  • access

    A patient's ability to obtain medical care. The ease of access is determined by components such as the availability of medical services and their acceptability to the patient, availability of insurance, the location of health care facilities, transportation, hours of operation, affordability and cost of care.

  • accreditation

    Approval by an authorizing agency for institutions and programs that meet or exceed a set of pre-determined standards.

  • activities of daily living (ADLs)

    Activities performed as part of a person's daily routine of self-care such as bathing, dressing, toileting and eating.

  • acute care

    Hospital care given to patients who generally require a stay of several days that focuses on a physical or mental condition requiring immediate intervention and constant medical attention, equipment and personnel.

  • administrative costs

    Costs related to activities such as utilization review, marketing, medical underwriting, commissions, premium collection, claims processing, insurer profit, quality assurance and risk management for purposes of insurance.

  • advanced practice nurse (APN)

    A registered nurse who is approved by the Board of Nursing to practice nursing in a specified area of advanced nursing practice. APN is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all RNs. There are four types: 1) certified registered nurse anesthetist (CRNA); 2) clinical nurse specialist (CNS); 3) certified nurse practitioner (CNP); and 4) certified nurse midwife (CNM).

  • adverse drug event (error)

    Any incident in which the use of medication (drug or biologic) at any dose, a medical device, or a special nutritional product may have resulted in an adverse outcome in a patient.

  • adverse event

    An injury resulting from a medical intervention that is not due to the underlying condition of the patient.

  • adverse selection

    Among applicants for a given group or individual health insurance program, the tendency for those with an impaired health status, or those who are prone to higher-than-average utilization of benefits, to be enrolled in disproportionate numbers in lower deductible plans.

  • aftercare

    Services following hospitalization or rehabilitation, individualized for each patient's needs. Aftercare gradually phases the patient out of treatment while providing follow-up attention to prevent relapse.

  • Agency for Healthcare Research and Quality (AHRQ)

    A federal agency within the Public Health Service responsible for research on quality, appropriateness and cost of health care. AHRQ also centralizes access to state inpatient data.

  • allied health personnel

    Specially trained and often licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists and nurses. The term is sometimes used synonymously with paramedical personnel, which are all health workers who perform tasks that must otherwise be performed by a physician, or health workers who do not usually engage in independent practice.

  • allopathic

    One of two schools of medicine that treat disease by inducing effects opposite to those produced by the disease. The other school of medicine is. osteopathic

  • allowable costs

    Charges for services rendered or supplies furnished by a health provider that qualify as covered expenses for insurance purposes.

  • alternative delivery

    An alternative to traditional inpatient care system such as ambulatory care, home health care and same-day surgery.

  • alternative medicine

    Treatment procedures that are not supported by mainstream medicine, often due to lack of supporting experimental data.

  • am.

    Amended. A designation sometimes found before a House or Senate bill number showing that formal changes have been made to an introduced piece of legislation during the legislative process.

  • ambulance restocking

    The practice of a hospital replenishing certain drugs and supplies used by an ambulance service during transport of a patient to the hospital.

  • ambulatory care

    Care given to patients who do not require overnight hospitalization.

  • ambulatory patient group (APG)

    The Medicare program's prospective payment system for outpatient services and procedures. Each APG is a classified medical service or procedure. Unlike diagnosis related group reimbursement for inpatient care, where medical events are condensed into one diagnostic related group, an outpatient visit can combine several different APGs.

  • ambulatory payment classification (APC)

    Groups or groupings of medical procedures and services used as a basis for reimbursement under the Medicare outpatient prospective payment system.

  • ambulatory setting

    An institutional health setting in which organized health services are provided on an outpatient basis, such as a surgery center, clinic or other outpatient facility. Ambulatory care settings also may be mobile units of service (e.g., mobile mammography, MRI).

  • ambulatory surgical facility

    see freestanding outpatient surgical center

  • American Accreditation Healthcare Commission (AAHC)

    An independent not-for-profit corporation that develops national standards for utilization review and managed care organizations.

  • American College of Healthcare Executives (ACHE)

    An international professional society of nearly 30,000 health care executives based in Chicago.

  • American Health Care Association (AHCA)

    A trade association representing nursing homes and long-term care facilities in the U.S. based in Washington,

  • American Hospital Association (AHA)

    A national association that represents allopathic and osteopathic hospitals in the U.S. AHA is based in Washington, D.C., with operational offices in Chicago.

  • American Medical Association (AMA)

    A national association organized into local and regional societies that represents over 700,000 medical doctors in the United States. AMA is based in Chicago.

  • American Osteopathic Association (AOA)

    A national association organized into local and regional societies that represents over 43,000 osteopathic physicians in the United States. AOA is based in Chicago and also provides accreditation for hospitals and colleges of osteopathic medicine.

  • American Society for Clinical Laboratory Science (ASCLS)

    An organization for clinical laboratory science practitioners, providing leadership and promoting all aspects of clinical laboratory science practice, education and management to ensure cost-effective laboratory services for health care consumers.

  • American Society for Clinical Pathology (ASCP)

    A national resource for the enhancement of the quality of the practice of pathology and laboratory medicine.

  • Americans with Disabilities Act (ADA)

    A federal law that prohibits employers of more than 25 employees from discriminating against any individual with a disability who can perform the essential functions, with or without accommodations, of the job that the individual holds or wants.

  • ancillary

    A term used to describe additional services performed related to care, such as lab work, X-ray and anesthesia.

  • anti-kickback statute

    A federal law that prohibits the paying or receiving of remuneration in exchange for the referral of patients or business paid by a federal health care program.

  • antitrust

    A situation in which a single entity, such as an integrated delivery system, controls enough of the practices in any one specialty in a relevant market to have monopoly power (e.g., the power to increase prices).

  • any willing provider

    A term used to describe legislation requiring a health plan to accept on its provider panels every physician, hospital or other practitioner that wants to participate in the health plan’s products.

  • approved health care facility or program

    A facility or program that is licensed, certified or otherwise authorized pursuant to the laws of the state to provide health care and that is approved by a health plan to provide the care described in a contract.

  • associate degree in nursing (ADN)

    A degree received after completing a two-year nursing education program at a college or university that qualifies a nurse to take a national licensing exam (NCLEX) to become a registered nurse.

  • attorney general

    Chief law enforcement officer of a state, responsible for advising the state or nation of legal matters.

  • average adjusted per capita cost (AAPCC)

    Payment rates used by the Centers for Medicare & Medicaid Services to reimburse managed care organizations for care delivered to Medicare enrollees.

  • average length of stay (ALOS)

    A standard hospital statistic used to determine the average amount of time between admission and departure for patients in a diagnosis related group, an age group, a specific hospital or other factors.

  • avian (or bird) flu

    Caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available. (see also seasonal flu and pandemic flu)

  • bachelor of science in nursing (BSN)

    A degree received after completing a four-year college or university program that qualifies a graduate nurse to take a national licensing exam (NCLEX) to become a registered nurse.

  • bad debt

    Results when patients do not pay bills for which payment was expected. It occurs for a variety of reasons, such as when uninsured patients have incomes above the guidelines for charity care, but still cannot afford the cost of their care.

  • balance billing

    A provider's billing of a covered person directly for charges above the amount reimbursed by the health plan. This may or may not be allowed, depending upon the contractual arrangements between the parties.

  • Balanced Budget Act of 1997 (BBA)

    A federal law enacted by U.S. Congress that makes numerous changes to various titles of the Social Security Act, contains significant changes to the Medicare and Medicaid programs, and creates a new Title XXI, the State Children's Health Insurance Program (SCHIP). Payment reductions and other changes enacted under the BBA likely will continue to be the focus of advocacy efforts for hospitals and other providers throughout the early 21st century.

  • Balanced Budget Refinement Act of 1999 (BBRA)

    A federal law enacted by U.S. Congress that restores an estimated $17 billion to the Medicare program. The law provides relief for hospitals, and includes special packages for rural and teaching hospitals, nursing homes and home health agencies.

  • behavioral health care

    Mental health services, including services for alcohol and substance abuse.

  • benchmarking

    A method of comparing the procedures and results of a process, system or operation under study with a similar process, system or operation under study that is generally recognized as outstanding.

  • beneficiary

    A person designated by an insuring organization as eligible to receive insurance benefits.

  • Benefits Improvement and Protection Act of 2000 (BIPA)

    A federal law enacted by U.S. Congress that, among other provisions, restores an estimated $11.5 billion over five years to hospitals under Medicare, Medicaid and other federal and state health care programs.

  • Blue Cross and Blue Shield Association (BC/BS)

    An organization that offers information, consultation, representation and operational services for the Blue Cross and Blue Shield plan members across the country for purposes of providing insurance benefits.

  • board certified

    A clinician who has passed the national examination in a particular field. Board certification is available for most physician specialties, as well as for many allied medical professions.

  • capitation (CAP)

    A stipulated dollar amount established to cover the cost of health care delivered for a person or group of persons. The term usually refers to a negotiated per capita rate to be paid periodically, usually monthly, to a health care provider. The provider is responsible for delivering or arranging for the delivery of all health services required by the covered person(s) under the conditions of the contract.

  • captive insurance

    A wholly owned subsidiary of a business or other legal entity, including a group of hospitals or trade associations, that is formed to insure risk. A captive is a form of self-insurance that has assumed the formalities of an insurance company.

  • careLearning

    An online education service of more than 40 state hospital associations along with the American Hospital Association (AHA) for the purpose of delivering more cost-effective education to hospitals.

  • CARE System

    The Core Analysis Research Evolution (CARE) System is a set of process measures used for quality improvement. The system meets Joint Commission and CMS core measurement requirements.

  • carrier

    The Medicare Part B claims processing contractor.

  • case manager

    A health care professional who monitors the allocation and coordination of a patient's overall care.

  • case mix index

    A measure of relative severity of medical conditions of a hospital's patients.

  • Centers for Disease Control and Prevention (CDC)

    An agency within the U.S. Department of Health and Human Services that serves as the central point for consolidation of disease control data, health promotion and public health programs.

  • Centers for Medicare & Medicaid Services (CMS)

    An agency within the U.S. Department of Health and Human Services responsible for the administration of the Medicare and Medicaid programs. Formerly called the Health Care Financing Administration.

  • charity care

    Health care provided at a substantial discount to those unable to pay. Hospitals either do not attempt to collect a portion of charges or agree to write off charges. Eligibility is sometimes determined from a sliding scale based on a percentage of the patient's income above the federal poverty level.

  • Children’s Health Insurance Program (CHIP)

    A state-administered program funded partly by the federal government that allows states to expand health coverage to uninsured, low-income children not eligible for Medicaid. Also called State Children’s Health Insurance Program (SCHIP).

  • Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

    A program that provides funds to pay for the treatment in private institutions for members of the uniformed services and their families. (see Tricare)

  • claims-made insurance policy

    A liability insurance policy under which coverage applies to claims filed during the policy period. Medical professional liability insurance is typically written on a claims-made basis.

  • Clinical Laboratory Improvement Amendments (CLIA)

    Federal law designed to set national quality standards for laboratory testing. The law covers all laboratories that engage in testing for assessment, diagnosis, prevention or treatment purposes.

  • clinical nurse specialist (CNS)

    A registered nurse with a graduate degree in nursing who may provide and manage the care of individuals and groups with complex health problems and provide health care services that promote, improve and manage health care within the nurse’s nursing specialty.

  • closed panel

    Medical services delivered in the health insuring corporation (HIC)-owned health center or satellite clinic by physicians who belong to a specially formed, but legally separate, medical group that only serves the HIC.

  • Consolidated Omnibus Budget Reconciliation Act

    see Omnibus Budget Reconciliation Act

  • Code of Federal Regulations (CFR)

    A publication of the federal government that consists of all regulations of federal departments and agencies.

  • co-insurance

    A specified dollar amount or percentage of covered expenses that an insurance policy or Medicare requires a beneficiary to pay toward eligible medical bills.

  • community benefit

    Hospital community benefit includes programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. A community benefit must meet at least one of the following criteria: generates a low or negative margin, responds to needs of special populations, supplies services that would likely be discontinued if considered on a purely financial basis, responds to public health needs, and/or involves education or research that improves overall community health.

  • Community Health Information Network (CHIN)

    A community-based activity that focuses on the development of a shared information database and retrieval system of patients, their medical histories and clinical and diagnostic tests.

  • community rating

    Setting insurance rates based on the average cost of providing health services to all people in a geographic area without adjusting for each individual’s medical history or likelihood of using medical services.

  • computerized physician order entry (CPOE)

    A system that allows physicians to write medical orders for their hospitalized patients using a clinical software application.

  • Congressional Budget Office

    A non-partisan office that provides U.S. Congress with cost estimates of legislative proposals and calculates estimates related to the federal budget.

  • Consolidated Omnibus Budget Reconciliation Act (COBRA)

    Health benefit provisions passed by Congress in 1986 amending the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to provide continuation of group health coverage that otherwise might be terminated.

  • continuing education unit (CEU)

    A uniform unit of measurement used to assess all levels of noncredit continuing education. One CEU is equivalent to 10 contact hours of participation in an organized continuing education experience.

  • coordination of benefits

    Provisions and procedures used by third-party payers to determine the amount payable when a claimant is covered under two or more health plans.

  • copayment

    A type of cost-sharing that requires the insured or subscriber to pay a specified flat dollar amount, usually on a per-unit-of-service basis, with the third-party payer reimbursing some portion of the remaining charges.

  • corporate campaign

    A strategy whereby a labor union aggressively attacks the public reputation of a target employer with a goal of forcing management to yield to the union's demands or risk the company's financial well-being.

  • corporate practice of medicine

    A state law doctrine that prohibits any person or entity other than a licensed physician from holding itself out as a provider of professional medical services, from billing in its name for such professional medical services, or from owning or controlling a professional medical delivery system.

  • cost

    The price a hospital must pay to provide a service, including the price of providing facilities, technology and workforce.

  • credentialing

    The process of reviewing a practitioner’s academic, clinical and professional ability as demonstrated in the past to determine if criteria for clinical privileges are met.

  • critical access hospital (CAH)

    A federal designation under which hospitals receive cost- based reimbursement for Medicare services. Hospitals must meet certain criteria, such as size, length of stay and proximity to other facilities.

  • critical pathway

    Standardized specifications for care developed by a formal process that incorporates the best scientific evidence of effectiveness with expert opinion.

  • deductible

    An amount which a policyholder agrees to pay, per claim or per accident, toward the total amount of an insured loss. Under a health insurance policy, the out-of-pocket expenses paid by the health insurance subscriber before the insurer will begin reimbursing the subscriber for additional medical expenses.

  • diagnostic related group (DRG)

    A classification system that groups patients by common characteristics requiring treatment.

  • Disability Medical Assistance

    A state administered program that provides limited medical assistance to persons who are medication-dependent and ineligible for any category of Medicaid. There is no federal funding or federal regulation of this program.

  • discharge planning

    The evaluation of patients' health needs for appropriate care after discharge from an inpatient setting.

  • disproportionate share hospital (DSH)

    A hospital that provides care to a high number of patients who cannot afford to pay and/or do not have insurance.

  • diversion

    The routing of patients to other hospitals because an emergency room is at maximum capacity.

  • doctor of osteopathy (DO)

    A licensed physician who is a graduate from an accredited school of osteopathic medicine.

  • do not resuscitate (DNR)

    An advance directive that patients may make to forego cardiopulmonary resuscitation or other resuscitative efforts. (see advance directive)

  • durable medical equipment (DME)

    Equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, generally is not useful to a person in the absence of illness or injury, and is appropriate for use at home, such as hospital beds, wheelchairs and oxygen equipment.

  • durable power of attorney

    A document in which individuals select another person to act on their behalf in the event they become incapacitated. The document may identify specific activities, such as managing the incapacitated person's financial affairs. If the document allows the agent to make health care decisions, it must be drafted in a manner that meets statutory requirements for a "health care durable power of attorney." (see advance directive)

  • electronic health record (EHR)

    A patient’s computerized health information as recorded and maintained by a provider system. An EHR is distinguished from a physician health record (PHR) by control: an EHR is controlled by the provider’s system while a PHR is owned and controlled by the patient.

  • emergency medical services (EMS)

    A system of health care professionals, facilities and equipment providing emergency care.

  • emergency medical services (EMS)

    A system of health care professionals, facilities and equipment providing emergency care.

  • emergency medical technician (EMT)

    A person certified to provide pre-hospital emergency medical treatment.

  • Employee Retirement Income Security Act (ERISA)

    A federal law that exempts self-insured health plans from state laws governing health insurance, including contribution to risk pools, prohibitions against disease discrimination and other state health reforms.

  • Environmental Protection Agency (EPA)

    A federal and state agency responsible for programs to control air, water and noise pollution, solid waste disposal and other environmental concerns.

  • exclusions

    Specific conditions or circumstances listed in an insurance contract for which the policy will not provide benefit payments. Exclusions can eliminate coverage for select individuals, groups, locations, properties or risks.

  • experience rating

    A system where an insurance company evaluates the risk of an individual or group by considering the applicant's loss history. For health insurance this would include evaluation of the applicant's health history.

  • Extended Reporting Period

    An additional period of time after policy expiration during which valid claims will be paid under a claims-made policy of liability insurance.

  • failure mode effect analysis

    A systematic method of identifying and preventing problems (errors) before they occur.

  • False Claims Act

    A federal law that imposes liability for treble damages and fines of $5,000 to $10,000 for knowingly submitting to the federal government a false or fraudulent claim for payment.

  • Farmers Home Administration (FHA)

    A division of the U.S. Department of Agriculture that guarantees hospital mortgages.

  • federal financial participation (FFP)

    The portion paid by the federal government to states for their share of expenditures for providing Medicaid services and for administering the Medicaid program and certain other human service programs. Also called federal medical assistance percentage (FMAP).

  • federal fiscal year (FFY)

    The federal government's accounting year, which begins Oct. 1 and ends Sept. 30 (e.g., FFY 2009 begins Oct. 1, 2008, and ends Sept. 30, 2009).

  • federal poverty guidelines

    The official annual income level for poverty as defined by the federal government. Under the 2008 guidelines, the federal poverty level for a family of four is $21,200.

  • Federal Register

    An official publication of the federal government that provides final and proposed regulations of federal legislation.

  • Federation of American Hospitals (FAH)

    A trade association composed of proprietary or investor-owned hospitals.

  • fee for service

    A method in which physicians and other health care providers receive a fee for services performed.

  • fee schedule

    A comprehensive listing of fees used by either a health care plan or the government to reimburse providers on a fee-for-service basis.

  • Fellow of American College of Healthcare Executives (FACHE)

    A credential awarded by the American College of Healthcare Executives.

  • fiscal intermediary

    see Medicare Administrative Contractor

  • fiscal note

    An analysis by the Legislative Budget Office of the financial impact of proposed state legislation.

  • fiscal year (FY)

    Any entity's accounting year.

  • Food and Drug Administration (FDA)

    An agency within the federal government that is responsible for regulations pertaining to food and drugs sold in the United States.

  • freestanding emergency medical service center

    A health care facility that is physically separate from a hospital and whose primary purpose is the provision of immediate, short-term medical care for minor but urgent medical conditions. (see "urgent care" )

  • freestanding outpatient surgical center

    A health care facility, physically separate from a hospital, that provides pre-scheduled, outpatient surgical services. (see surgicenter or ambulatory surgical facility ambulatory surgical facility)

  • full-time equivalent (FTE)

    A standardized accounting of the numbers of full-time and part-time employees.

  • gatekeeper

    A primary care physician responsible for overseeing and coordinating all aspects of a patient’s medical care and pre-authorizing specialty care.

  • general practitioner

    A physician whose practice is based on a broad understanding of all illnesses and who does not restrict his/her practice to any particular field of medicine.

  • going bare

    The colloquial term describing the choice of an individual, provider or other legal entity not to purchase liability insurance such as medical liability insurance or have a self-insurance mechanism such as a trust fund, or captive insurance company.

  • Government Accountability Office (GAO)

    A non-partisan investigative arm of U.S. Congress that evaluates federal programs as an oversight of federal spending, efficiency and performance.

  • graduate medical education (GME)

    Medical education as an intern, resident or fellow after graduating from a medical school

  • group insurance

    Any insurance policy or health services contract by which groups of employees (and often their dependents) are covered under a single policy or contract, issued by their employer or other group entity.

  • group model HMO

    An HMO that contracts with a multi-specialty medical group to provide care for HMO members. Members are required to receive medical care from a physician within the group unless a referral is made outside the network.

  • group practice association

    A formal arrangement of three or more physicians or other health professionals providing health services. Income is pooled and redistributed to the members of the group according to a prearranged plan.

  • health care-acquired condition

    see hospital-acquired condition

  • health care durable power of attorney

    A document in which individuals select another individual to make health care decisions for them in the event they become incapacitated. A health care durable power of attorney should be distinguished from a living will, a document drafted by an individual that provides direction regarding medical care if the individual becomes incapacitated by terminal illness or permanent unconsciousness. (see advance directive )

  • Health Employer Data and Information Set (HEDIS)

    A set of performance measures designed to standardize the way health plans report data to employers. HEDIS measures five major areas of health plan performance: quality, access and patient satisfaction, membership and utilization, finance, and descriptive information on health plan management.

  • Health Insurance Association of America (HIAA)

    A corporate member association of health and accident insurance companies.

  • Health Insurance Portability and Accountability Act (HIPAA)

    Federal legislation, enacted in 1996, mandating regulations governing privacy, security and administrative simplification standards for health care information. HIPAA governs how health care organizations handle all facets of information management, including patient records.

  • health maintenance organization (HMO)

    An entity that offers prepaid, comprehensive health coverage for both hospital and physician services with specific health care providers using a fixed fee structure or capitated rates.

  • health savings account

    Formerly called medical savings accounts (MSAs), a method of financing health care by giving tax advantages to individuals who establish and maintain personal accounts for health care purposes; similar to an Individual Retirement Account for retirement purposes. The health savings account legislation was signed into law in 2003, making the HSA the next generation of MSA plans.

  • Healthy Start/Healthy Families

    A Medicaid program that provides health care for pregnant women, children and parents who are at or below a specified level of income and age.

  • Hill-Burton Act

    Federal legislation enacted in 1947 to support the construction and modernization of health care institutions. No funds have been appropriated since the late 1960s.

  • home health agency

    An organization that provides medical, therapeutic or other health services in patients' homes.

  • hospice

    A facility or program that is licensed, certified or otherwise authorized by law that provides supportive care of the terminally ill.

  • hospital-acquired condition (HAC)

    Conditions that could reasonably have been prevented through the application of evidence based guidelines.

  • hospital-acquired infection (HAI)

    An infection acquired by an individual while receiving care or services in a health care organization.

  • hospital affiliation

    A contractual relationship between a health insurance plan and one or more hospitals whereby the hospital provides the inpatient benefits offered by the plan.

  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

    Standardized survey instrument and data collection methodology for measuring patients' perceptions of their hospital experience.

  • Hospital Incident Command System (HICS)

    An incident management system based on the Incident Command System that assists hospitals in improving their emergency management planning, response and recovery capabilities for planned and unplanned events.

  • Hospital Insurance Program

    The compulsory portion of Medicare that relates to hospital care. (see Medicare Part A)

  • hospitalist

    Specialists in the provision of medical care for hospitalized patients, who manage the general medical needs of patients in the hospital. Most at this time are physicians; however, nurse practitioners and physician assistants may also be involved in the hospitalist's role, including managing the medical continuum of hospital care and the planning of post-hospital care.

  • hospital market basket

    Components of the overall cost of health care used in determining the consumer price index.

  • Hospital Market Basket Index

    An inflationary measure of the cost of goods and services purchased by health care facilities, often used to determine growth in reimbursement rates.

  • indemnity insurer

    An insurance company that offers selected coverage within a framework of fee schedules, limitations and exclusions as negotiated with subscriber groups, generally paying providers fees according to services rendered.

  • independent practice association (IPA)

    A health care delivery model in which an association of independent physicians contracts with health maintenance organizations and preferred provider organizations for physicians' services. The IPA physicians practice in their own offices and continue to see fee-for-service patients.

  • indigent medical care

    Care given by health care providers to patients who are unable to pay for it.

  • inpatient

    An individual who has been admitted to a hospital for at least 24 hours.

  • integrated delivery system

    Collaboration between physicians and hospitals for a variety of purposes. Some models of integration include physician-hospital organization, management-service organization, group practice without walls, integrated provider organization and medical foundation

  • intermediate care facility

    A facility providing a level of medical care that is less than the degree of care and treatment that a hospital or skilled nursing facility is designed to provide, but greater than the level of room and board.

  • International Classification of Diseases, 9th Revision (ICD-9-CM)

    The classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations for data storage and retrieval.

  • International Classification of Diseases, 10th Revision (ICD-10-CM)

    The proposed revised classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations for data storage and retrieval. ICD 10th revision contains a significant increase in codes over ICD-9, including the addition of a sixth character, codes relevant to ambulatory and managed care encounters, expanded injury codes and greater specificity in code assignment.

  • intractable pain

    Pain for which there is no cure

  • IRS Form 990

    The tax-exempt return most charitable organizations, including hospitals, file with the IRS each year. It includes income, expenditures and activities, as well as compensation of high-level employees and lobbying expenditures and certain other activities.

  • Joint Commission

    Founded in 1951, the Joint Commission evaluates and accredits health care organizations in the U.S., including hospitals, health plans, and other care organizations that provide home care, mental health care, laboratory, ambulatory care and long-term services. Formerly called the Joint Commission on Accreditation of Healthcare Organizations.

  • Joint Commission Resources (JCR)

    A subsidiary of the Joint Commission designed to distribute consulting and publication services.

  • joint venture

    A loose form of affiliation, essentially contractual in nature, that preserves the prior legal identity of each party participating in the venture.

  • The Leapfrog Group

    A group of Fortune 500 employers and other purchasers of health care, sponsored by the Business Roundtable, focused on patient safety issues.

  • length of stay (LOS)

    The number of days a patient stays in a hospital or other health care facility.

  • licensed practical nurse (LPN)

    A graduate from a one-year vocational or technical nursing program who has been licensed by the state.

  • licensed social worker (LSW)

    An individual who is licensed by the state to practice social work.

  • Life Safety Code

    Standards of construction, protection and occupancy that are necessary to minimize danger to life from fire, smoke, fumes and panic. The Joint Commission and the Centers for Medicare & Medicaid Services require compliance with the code. The code is adopted and published by the National Fire Protection Association and is also known as the NFPA 101.

  • limited-service, physician-owned hospital

    A health care provider designed to provide principally one or two specialties of medical care (such as orthopedic or cardiac care), whose practicing physicians are also owners or investors. Also called a niche or specialty hospital.

  • living will

    A legal document generated by an individual to guide providers on the desired medical care in cases when the individual is unable to articulate his or her own wishes. (see advance directive)

  • long-term acute care hospital (LTCH or LTACH)

    A hospital that specializes in treating patients with serious and often complex medical conditions requiring a longer length of stay than customarily provided by a traditional acute care hospital. LTCHs provide care for such conditions as respiratory failure, non-healing wounds, and other medically complex diseases.

  • long-term care (LTC)

    Care given to patients with chronic illnesses who usually require a length of stay longer than 30 days.

  • low-level radioactive waste

    Waste that has a low intensity of radioactivity, most of which decays to acceptable levels within a few months, but a few of which contain radioactivity for hundreds of years.

  • Magnet Hospital Recognition Program

    A designation through the American Nurses Credentialing Center that recognizes those institutions that act as a “magnet” by creating a work environment that recognizes and rewards professional nursing.

  • Magnetic Resonance Imagining (MRI)

    A diagnostic technique that uses radio and magnetic waves, rather than radiation, to create images of body tissue and to monitor body chemistry.

  • major diagnostic category (MDC)

    A hospital classification system that groups patients by diseases and disorders of each major body system. Diagnostic related groups are classified underneath each MDC.

  • malpractice

    The improper treatment of a patient, as by a physician or nurse, resulting in injury.

  • managed care

    A system of health care delivery that influences utilization and cost of services, and often includes a capitated payment structure and a limited choice of health care providers.

  • Management Service Organization (MSO)

    A legal entity that provides practice management, administrative and support services to individual physicians or group practices. An MSO may be a direct subsidiary of a hospital, a joint venture with physicians, a physician-owned organization or an investor-owned expertise.

  • market basket

    see hospital market basket

  • Market Basket Index

    see Hospital Market Basket Index

  • Medicaid

    A state-administered program funded partly by the federal government that provides health care services for certain low-income persons and certain aged, blind or disabled individuals. The program is approximately a 40/60 state/federal match.

  • Medical Consumer Price Index

    An inflationary statistic that measures the cost of all purchased health care services.

  • medical doctor (MD)

    A licensed physician who is a graduate of an accredited medical school and practices allopathic medicine.

  • medical error

    The failure of a planned action to be completed as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning).

  • medical malpractice insurance

    Insurance purchased by a person or entity, such as a doctor or hospital, to protect the person or entity from claims from third parties for medical error or medical malpractice. Also known as medical professional liability insurance.

  • medical savings account (MSA)

    A method of financing health care by giving tax advantages to individuals who establish and maintain personal accounts for health care purposes; similar to an Individual Retirement Account for retirement purposes A news health savings account legislation was signed into law in 2003, making the HAS the next generation of MSA plans. (see health savings account).

  • Medicare

    A federally funded program that provides health insurance primarily for individuals entitled to Social Security who are age 65 or older.

  • Medicare Advantage

    Also referred to as “Medicare Part C,” or “Medicare+Choice,” a Medicare program under which eligible Medicare enrollees can elect to receive benefits through a managed care program that places providers at risk for those benefits.

  • Medicare Dependent

    A Medicare reimbursement category for a hospital that is located in a rural area, has no more than 100 beds, and has had at least 60 percent of its inpatient days or discharges attributed to Medicare beneficiaries during a cost report year beginning in federal fiscal year 1987.

  • Medicare Modernization Act of 2003 (MMA)

    Federal law that provided a prescription drug benefit under the Medicare program. MMA made various other adjustments to the Medicare and Medicaid programs affecting providers, including payment and regulatory improvements for hospitals. Also known as the Medicare Prescription Drug Bill.

  • Medicare Part A

    The part of the Medicare program covering inpatient hospital services and services furnished by other health care providers such as nursing homes, home health agencies and hospices. Part A coverage is automatically provided for individuals entitled to Medicare.

  • Medicare Part B

    The part of the Medicare program that covers outpatient, physician and medical supplier services. Part B coverage is optional and must be paid for separately through monthly premium payments.

  • Medicare Part C

    see Medicare Advantage

  • Medicare Part D

    The part of the Medicare program that covers prescription drug coverage. Beginning in 2006, beneficiaries have access to partial prescription drug coverage paid mainly through state payments, premiums and general revenue. Some assistance for low-income beneficiaries is available for premiums and co-pays.

  • Medicare Payment Advisory Commission (MedPAC)

    A non-partisan congressional advisory body charged with providing policy advice and technical assistance concerning the Medicare program and other aspects of the health system. It conducts independent research, analyzes legislation, and makes recommendations to U.S. Congress. The Physician Payment Review Commission has been merged with the Prospective Payment Assessment Commission to create MedPAC.

  • medigap

    A policy guaranteeing to pay a Medicare beneficiary’s co-insurance, deductible and co-payments and provide additional health plan or non-Medicare coverage for services up to a predefined benefit limit. In effect, the product pays for the portion of the cost of services not covered by Medicare.

  • morbidity

    Incidents of illness and accidents in a defined group of individuals.

  • mortality

    Incidents of death in a defined group of individuals.

  • most-favored-nation (MFN) clause

    A provision requiring the contracting physician, hospital or group to provide an insurer with the lowest price it charges any other insurer.

  • National Accrediting Agency for Clinical Laboratory Science (NAACLS)

    A division within the U.S. Department of Health and Human Services that supports analyses and evaluations of the health care system and its financing, and underwrites the development and testing of new approaches to improve the distribution, use and cost-effectiveness of services.

  • National Board of Medical Examiners (NBME)

    A nonprofit organization responsible for preparing and administering qualifying examinations for physicians.

  • National Cancer Registry

    A unit within the National Institutes of Health that provides updates on the latest cancer diseases, research and diagnosis.

  • National Center for Health Statistics (NCHS)

    A division within the U.S. Department of Health and Human Services that is responsible for gathering data on illness and disability, producing the vital statistics of the nation and tracking the use and availability of health services and resources.

  • National Committee for Quality Assurance (NCQA)

    A nonprofit organization created to improve patient care quality and health plan performance in partnership with managed care plans, purchasers, consumers, and the public sector.

  • National Credentialing Agency for Laboratory Personnel (NCA)

    A peer-established agency providing practice-driven credentials for laboratory professionals.

  • National Incident Management System (NIMS)

    A standardized approach to incident management and response that establishes a uniform set of processes and procedures that emergency responders at all levels of government will use to conduct response operations. Currently there are 14 elements that are specific to hospitals and health care organizations.

  • National Information Center on Health Services Research and Health Care Technology (NICHSR)

    A division within the U.S. Department of Health and Human Services that supports analyses and evaluations of the health care system and its financing, and underwrites the development and testing of new approaches to improve the distribution, use and cost-effectiveness of services.

  • National Institutes of Health (NIH)

    A division within the U.S. Department of Health and Human Services that is responsible for most of the agency's medical research programs.

  • National Quality Forum (NQF)

    A not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.

  • Never Event

    see preventable adverse event

  • Nuclear Regulatory Commission (NRC)

    A federal commission created in 1974 to protect the public health and safety by regulating civilian uses of nuclear materials.

  • Nursing 2015

    Legislation signed by Gov. Ted Strickland on June 12, 2008, that requires hospitals to develop staffing committees that will make recommendations to hospital administration for adoption of staffing plans.

  • nursing quality indicators

    A set of 10 nursing-sensitive indicators that link nursing interventions to patient outcomes.

  • Occupational Safety and Health Administration (OSHA)

    A federal agency within the U.S. Department of Labor that is responsible for setting standards to promote and enforce employee safety in the workplace.

  • Office of Inspector General (OIG)

    The enforcement arm within the U.S. Department of Health and Human Services that oversees investigations of alleged violations of Medicare and Medicaid laws and rules. (Most federal agencies have their own OIG.)

  • Office of Management and Budget (OMB)

    A federal agency responsible for providing fiscal accounting and budgeting services for the federal

  • Office of Professional Standard Review Organizations

    The health standards and quality bureau of the Centers for Medicare & Medicaid Services.

  • Office of the Assistant Secretary for Preparedness and Response (ASPR)

    The federal agency within the U.S. Department of Health and Human Services that provides health care preparedness grants.

  • Omnibus Budget Reconciliation Act (OBRA)

    An amendment to the federal budget that outlines new federally funded programs or revisions to existing programs.

  • operating margin

    The ratio of operating costs to revenue that are directly related to patient care.

  • organ procurement organization (OPO)

    A nonprofit, federally funded organization that aids in the organ transplantation process.

  • ORYX

    The integration of performance measurement into the Joint Commission's accreditation process. Each accredited facility must select vendors that have been approved by the Joint Commission for the performance measurement system.

  • osteopathic

    One of two schools of medicine that uses manipulative measures in treating patients in addition to the diagnostic and therapeutic measures of medicine. The other school is allopathic.allopathic

  • outcome measures

    Assessments to gauge the results of treatment for a particular disease or condition. Outcome measures include the patient's perception of restoration of function, quality of life and functional status, as well as objective measures of mortality, morbidity and health status.

  • outlier

    A patient case that falls outside of the established norm for diagnosis related groups.

  • out-of-area benefits

    The coverage allowed to HMO members for emergency and other situations outside of the prescribed geographic area of the HMO.

  • outpatient

    A person who receives health care services without being admitted to a hospital.

  • outpatient prospective payment system (OPPS)

    A method of financing health care that mandates payments in advance for the provision of outpatient services and is based on ambulatory payment classification.

  • palliative care

    Care for not only physical symptoms, but also for emotional, social, spiritual, psychological and cultural symptoms to achieve the best possible quality of life. Palliative care is usually provided at the end of life or to help deal with chronic conditions.

  • pandemic flu

    Virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. see also avian flu and seasonal flu

  • participating provider

    A health care provider who has a contractual arrangement with a health care service contractor, HMO, PPO, IPA, or other managed care organization.

  • Patient Safety Organization (PSO)

    An entity certified by the Secretary of Health and Human Services that contracts with providers to collect and review patient treatment data for the purpose of improving health care quality, outcomes, and patient safety. The framework creating a national network of PSOs was established by the Patient Safety and Quality Improvement Act of 2005.

  • Patient Self-Determination Act

    A federal law that requires health care facilities to determine if new patients have a living will and/or durable power of attorney for health care and take patients' wishes into consideration in developing their treatment plans.

  • payer

    A public or private organization that pays for or underwrites coverage for health care expenses.

  • payment

    Reimbursement a hospital receives for care provided; usually less than the standard charge and sometimes less than the cost of providing care.

  • peer review

    The evaluation of quality of total health care provided by medical staff with equivalent training.

  • peer review organization (PRO)

    An entity established by the Tax Equity and Fiscal Responsibility Act of 1982 to review quality of care and appropriateness of admissions, readmissions and discharges for Medicare and Medicaid. These organizations are held responsible for maintaining and lowering admission rates, and reducing lengths of stay while insuring against inadequate treatment. Now called quality improvement organizations.

  • per diem

    A method of payment in which a provider receives a fixed payment for each day of service provided to a patient.

  • per member per month (PMPM)

    The amount of money paid or received on a monthly basis for each individual enrolled in a managed care plan, often referred to as capitation.

  • physician-hospital organization (PHO)

    A legal entity formed and owned by one or more hospitals and physician groups in order to obtain payer contracts and to further mutual interests; one type of integrated delivery system.

  • point-of-service (POS)

    An insurance plan where members need not choose how to receive services until the time they need them, also known as an open-ended HMO.

  • political action committee (PAC)

    A group of people organized to collect and distribute contributions to political candidates.

  • pre-admission testing (PAT)

    Patient tests performed on an outpatient basis prior to admission to the hospital.

  • pre-existing condition

    An illness or other medical condition that a patient has experienced before the effective date of insurance coverage.

  • preferred provider organization (PPO)

    A panel of physicians, hospitals and other health care providers of services to an enrolled group for a fixed periodic payment.

  • prenatal care

    Services to pregnant women designed to ensure that both the expectant mother and the newborn are in the best health.

  • present on admission (POA)

    Conditions known at the time of admission to the hospital, as well as conditions clearly present before, but not diagnosed until after admission.

  • preventive care

    Comprehensive care emphasizing priorities for prevention, early detection and early treatment of conditions, generally including routine physical examination and immunizations.

  • preventable adverse event

    An event that results in death, loss of a body part, disability, or loss of bodily function lasting more than seven days or still present at the time of discharge from an inpatient health care facility. Also referred to as a never event.

  • primary care

    Entry-level care which may include diagnostic, therapeutic or preventive services.

  • professional liability

    see medical malpractice insurance

  • prospective payment system (PPS)

    A method of financing health care that mandates payments in advance for the provision of services and is based on diagnostic related groups.

  • provider

    A hospital, physician, group practice, nursing home, pharmacy or any individual or group of individuals that provides a health care service.

  • Provider Reimbursement Review Board

    A federal board responsible for making decisions regarding provider appeals on Medicare reimbursement issues.

  • provider-sponsored organization (PSO)

    A provider-owned entity that is certified by the Centers for Medicare & Medicaid Services to participate in the Medicare+Choice program and to assume risk for benefits provided to Medicare beneficiaries.

  • Public Health Service

    A federal agency responsible for public health services and programs including biomedical research.

  • quality assurance

    A formal set of activities to review and improve the quality of services provided. Quality assurance includes quality assessment and corrective actions to remedy any deficiencies identified in the quality of direct patient, administrative and support services.

  • quality improvement

    A continuous effort to provide services at the highest level of quality at the lowest level of cost.

  • quality improvement organization (QIO)

    An independent organization responsible for ensuring that medical care paid under the Medicare program is reasonable and medically necessary, that it meets professionally recognized standards and that it is provided in the most economical setting.

  • radiographer

    The preferred title for health care workers who take X-rays and have a degree to provide complication radiological services.

  • rate-setting

    The determination by a government body of rates a health care provider may charge private-pay patients.

  • Recovery Audit Contractor (RAC)

    A national provider bill and medical services review project authorized by Congress and managed by the Centers for Medicare & Medicaid Services to detect and correct improper payments in the Medicare fee-for-service program.

  • refined diagnosis related group (RDRG)

    An expanded list of diagnosis-related groups to take into account a patient's severity of illness.

  • reinsurance

    A type of insurance purchased by primary insurers from secondary insurers. A commercial or captive insurance company purchases reinsurance to protect against part of all losses the primary insurer might assume in honoring claims of its policyholders. Typically, a primary insurer pays a claim up to a specified amount, and then a reinsurer pays the remainder of the claim.

  • required request

    A system enacted by state lawmakers in 1987 requiring hospitals to request organs from a deceased’s family when the deceased is determined to be medically suitable.

  • Research and Educational Foundation (REF)

    A nonprofit foundation of OHA that directs a variety of research projects.

  • Resource-Based Relative Value Scale (RBRVS)

    Medicare fee schedule for physician services that sets a uniform payment in each geographic area for most of the approximately 7,000 medical procedures.

  • return on investment (ROI)

    A measure of a company's ability to use its assets to generate additional value for shareholders. It is calculated as net profit divided by net worth and is expressed as a percentage.

  • risk

    The chance or possibility of loss. Also used to refer to the insured or to the property coverage by a policy. Risk is also defined in health insurance terms as the possibility of loss associated with a given population. In an HMO setting, often employed as a utilization control mechanism.

  • risk classification

    The process by which a company decides how its premium rates should differ according to the risk characteristics of individual insureds.

  • risk management

    The practice of identifying and analyzing loss exposures and taking steps to minimize the financial impact of the risks they impose. Traditional risk management, sometimes called "insurance risk management," has focused on "pure risks" (i.e., possible loss by fortuitous or accidental means), but not business risks (i.e., those that may present the possibility of loss or gain).

  • root cause

    The most fundamental reason for the failure or inefficiency of a process. Also called underlying cause.

  • root cause analysis (RCA)

    A process for identifying the basic factor(s) that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event.

  • routine notification

    A system being proposed at the state and national levels requiring hospitals to call a regional phone number when death is imminent to determine if organs are suitable for transplantation.

  • safety net providers

    Providers who have a mission or mandate to deliver large amounts of care to uninsured or other vulnerable patients (e.g., public hospitals, teaching hospitals, community health centers or clinics).

  • seasonal (or common) flu

    A respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. see also avian flu and pandemic flu

  • selective contracting

    The practice of a managed care organization (MCO) by which the MCO enters into participation agreements only with certain providers (and not with all providers who qualify) to provide health care services to health plan participants as members of the MCO's provider panel.

  • sentinel event

    An unexpected occurrence involving death or serious physical or psychological injury, or the risk, thereof.

  • skilled nursing facility (SNF)

    A facility, either freestanding or part of a hospital, that accepts patients in need of rehabilitation and medical care that is of a lesser intensity than is received in the acute care setting of a hospital.

  • smallpox health care team

    Groups of health care workers identified by hospitals who are vaccinated and trained to provide direct medical care for the first smallpox patients requiring hospital admission and to evaluate and manage patients with suspected smallpox who are examined at emergency departments. This team provides 24-hour care for the first two days or more after patients with smallpox have been identified, until additional health care personnel are vaccinated.

  • Social Security Administration

    The administrative branch of the federal government established in 1935 to provide old age and survivor benefits.

  • staff model HMO

    An HMO that delivers health services through a group in which physicians are salaried employees who treat HMO members exclusively.

  • Stark

    The commonly used name for federal laws and regulations that ban physician referral to entities with which the physician has a financial relationship. Named for U.S. Rep. Fortney "Pete" Stark, who sponsored much of the legislation.

  • State Children’s Health Insurance Program (SCHIP)

    see Children’s Health Insurance Program (CHIP)

  • state fiscal year (SFY)

    The state government's accounting year, which begins July 1 and ends June 30 (e.g., SFY 2009 begins July 1, 2008, and ends June 30, 2009).

  • stop loss

    The point at which a third party has reinsurance to protect against the overly large single claim or the excessively high aggregate claim during a given period of time. Large employers that self-insure may purchase reinsurance for stop loss purposes.

  • subacute care

    Care given to patients who require less than a 30-day length of stay in a hospital and who have a more stable condition than those receiving acute care.

  • supplemental medical insurance

    Private health insurance, also called medigap insurance, designed to supplement Medicare benefits by covering certain health care costs that are not paid for by the Medicare program.

  • Supplemental Security Income (SSI)

    A federal program of income support for low income, aged, blind and disabled persons established by Title XVI of the Social Security Act. Qualification for SSI often is used to establish Medicaid eligibility.

  • surgicenter

    see freestanding outpatient surgical center

  • swing beds

    Acute care hospital beds that can also be used for a different level of care.

  • system error

    An error that is not the result of an individual's action, but the predictable outcome of a series of actions and factors that comprise a diagnostic or treatment process.

  • tail insurance

    Also known as an Extended Reporting Period, an additional period of time after policy expiration during which valid claims will be paid under a claims-made policy of liability insurance. Most hospital and physician medical professional liability policies are written on a claims-made basis. Tail insurance may be needed when an insured changes insurance companies or retires.

  • Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

    A federal law that authorizes health plans to enter into arrangements with the Centers for Medicare & Medicaid Services for cost and risk contracts.

  • teaching hospital

    A hospital that has an accredited medical residency training program and is typically affiliated with a medical school.

  • telemedicine

    Health care consultation and education using telecommunication networks to transmit information.

  • tertiary care

    Highly specialized care given to patients who are in danger of disability or death.

  • third-party administrator

    A person or organization that manages the payment, processing and settlement of life, health, dental, disability and self-insured insurance claims for another person or organization.


    A section of the U.S. Social Security Act that authorizes and details the parameters of the Medicare Program.


    A section of the U.S. Social Security Act that authorizes and details the parameters of the Medicaid Program.


    A section of the U.S. Social Security Act that establishes the Children’s Health Insurance Program (CHIP).

  • tort

    A negligent or intentional civil wrong not arising out of a contract or statute that injures someone in some way, and for which the injured person may sue the wrongdoer for damages.

  • total margin

    The ratio of total revenue to total costs or expenses, including non-patient care (e.g., parking lots).

  • transparency

    A movement toward providing more information to the public on hospital operation costs and quality.

  • triage

    The process by which patients are sorted or classified according to the type and urgency of their conditions.

  • Tricare

    A regionally managed health care program for active duty and retired members of the uniformed services and their families; created by the Department of Defense. (see Civilian Health and Medical Program of the Uniformed Services)

  • UB-04

    The revised universal institutional health insurance data set and data form.

  • uncompensated care

    Health care services received, but not fully paid for, either out-of-pocket by individuals or by an insurance provider. (see charity care)

  • underinsured

    With respect to health insurance, people who lack sufficient health coverage, which may affect their ability to access or pay for needed health services.

  • underlying cause

    The most fundamental reason for the failure or inefficiency of a process. Also called root cause.

  • uniform hospital discharge data set

    A defined set of data that gives a minimum description of a hospital discharge. It includes data on age, sex, race, residence of patient, length of stay, diagnosis, physicians, procedures, disposition of the patient and sources of payment.

  • uninsured

    With respect to health insurance, people who lack health insurance of any kind.

  • unpreventable adverse event

    An adverse event resulting from a complication that cannot be prevented given the current state of knowledge.

  • urgent care

    see freestanding emergency medical service center

  • U.S. Department of Health and Human Services (HHS)

    A department within the executive branch of the federal government responsible for Social Security and federal health programs in the civilian sector.

  • U.S. House Committee on Energy and Commerce

    A congressional committee whose primary jurisdiction includes many health care-related issues, such as public health, patient protection, food and drug safety and oversight of Medicaid and other Health and Human Services programs.

  • U.S. House Committee on Ways and Means

    A congressional committee with primary oversight of Medicare, Social Security and other public welfare programs. Also responsible for legislation concerning taxes, bonded debt and tariffs.

  • U.S. Senate Committee on Finance

    A congressional committee dealing with Medicare, Medicaid, federal bonds, the customs service and related issues, public moneys, revenue sharing, health programs funded by specific taxes, national social security and general revenue matters. Members of this committee have significant influence over the development of federal health care policy and funding.

  • U.S. Senate Committee on Health Education, Labor and Pensions (HELP)

    A congressional committee whose primary jurisdiction includes many hospital- and health care-related issues, including public health, labor practices, workplace safety, care for children and the elderly, biomedical research and social welfare programs.

  • usual, customary and reasonable charges (UCR)

    Charges for health care services in a geographical area that are consistent with the charges of identical or similar providers in the same geographic area.

  • utilization

    The patterns of use of a service or type of service within a specified time, usually expressed in a rate per unit of population-at-risk for a given period (e.g., the number of hospital admissions per year per 1,000 persons in a geographic area).

  • utilization review (UR)

    An evaluation of the necessity and appropriateness of the use of health care services, procedures and facilities.

  • Veterans' Administration (VA)

    A federal agency responsible for veterans including VA hospitals and veterans' benefits.

  • wage index

    A factor used to adjust the base Medicare reimbursement rates for an area to account for geographic differences in wages paid to health care workers. Some argue that such differences no longer exist and that the wage index formula should be changed or eliminated.

  • weapons of mass destruction

    Weapons capable of inflicting mass casualties and destruction; including nuclear, biological and chemical weapons or the means to deliver them.

  • well-baby care

    Services provided in the first year of a newborn's life to identify, treat and prevent health care problems.