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A GLOSSARY OF HEALTH CARE TERMS
The Glossary, published in May 1999, contains definitions of important health care terms and provides useful information to those endeavoring to understand the often confusing language used in connection with the delivery of health care today. This newly published fourth edition contains additional information relative to the delivery of health care via telemedicine and reflects the many changes in health care today.
Copies of the entire Glossary in its original printed booklet format are available from the Webmaster. A portion of the contents of the third edition of the Glossary appears below.
HEALTH CARE TERMS
The process by which a private or public agency evaluates and recognizes a program of study or an institution as fulfilling applicable standards. The determination that a program or institution meets these standards is also referred to as accreditation of the program or institution. For example, the Joint Commission on Accreditation of Health Care Organizations, a private organization, evaluates whether hospitals, nursing homes and managed care organizations meet certain specified requirements; the Accreditation Association for Ambulatory Health Care and the National Committee for Quality Assurance assess and award compliance certifications to managed care organizations, including HMOs (see definitions for these terms). Public agencies sometimes require accreditation by a private body as a condition of licensure or may accept accreditation as a substitute for their own inspection or certification programs.
One of three major accreditation organizations that assess and award compliance certifications to managed care organizations, including HMOs. See accreditation.
Bathing, dressing and grooming, walking and moving about, eating, using the toilet, communicating and other similar tasks relating to personal care. In order to receive benefits under group adult foster care or long term care insurance (see definitions), an individual must require assistance with a specified number of ADLs.
The amount that a health care provider actually bills a patient for medical services rendered to the patient. Compare allowable, customary, prevailing or reasonable charge.
The practice of medicine based on traditional Chinese theories. Acupuncture consists primarily of the insertion of metal needles through the skin at certain points on the body in an attempt to relieve pain or improve bodily functions. Many states require the registration or licensing of acupuncturists.
A day during which a patient remains in a health care facility (typically, an acute care hospital) at a level of care higher (and usually more expensive) than the level required by his or her medical condition. The term, often abbreviated to “AD” or “AND,” is used in connection with third-party reimbursement calculations.
A written agreement between a patient and a hospital or other inpatient health care facility, specifying the rights and obligations of both parties in connection with admission to, residence at and discharge from the facility. The content of an admission agreement is increasingly regulated by both state and federal law, and may address such matters as payment obligations, patients’ rights, policies regarding the protection of patients’ property, procedures for applying for Medicare or Medicaid program benefits, instructions for contacting resident advocacy groups or the state ombudsman and other matters.
Specially trained and/or licensed health care workers, other than physicians, dentists, podiatrists, chiropractors, optometrists and nurses. Although the term has no specific meaning, it typically includes such health care professionals as laboratory and radiologic technicians, physical and occupational therapists and athletic trainers. In Massachusetts, certain allied health professionals are subject to regulation by the Boards of Registration for Allied Health Professionals and Allied Mental Health Professionals.
The maximum amount that a provider of health care services may expect to receive for a particular service or product from a third-party payor (such as an insurance company, a preferred provider organization, the Medicare program or Blue Cross). An allowable charge may be less than the actual charge a provider has billed or would like to bill a patient, and may or may not reflect the actual cost to the provider of providing the service. Compare actual, customary, prevailing or reasonable charge.
A specialized accounting term used to refer to an expense, incurred by a provider of health care services, that will eventually be reimbursed by a third-party payor. Under both the Medicare and Medicaid programs, certain providers are required to report their costs to the agency, who will audit them and incorporate those costs that are “allowed” under the rules of the program into reimbursement paid to the provider. Allowable costs do not necessarily equal the actual costs incurred by a provider, and may exclude some expenses.
Health care services rendered by a provider, such as a hospital or clinic, on an outpatient basis (as opposed to inpatient services).
A service, other than the provision of room and board, provided by a hospital or other care facility, such as X-ray, laboratory or professional services.
A residential community for elderly individuals who do not require full-time nursing care or supervision. Under Massachusetts law, assisted living residences in the Commonwealth must be certified by the Executive Office of Elder Affairs.
Copyright © 1998, Alan S. Goldberg, All Rights Reserved.
Last revised: 6/7/99