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59 Cards in this Set
- Front
- Back
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Accreditation
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1. A voluntary process of institutional or organizational review in which a quasi-independent body created for this purpose periodically evaluates the quality of the entity’s work against preestablished written criteria 2. A determination by an accrediting body that an eligible organization, network, program, group, or individual complies with applicable standards
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Acute care
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Medical care of a limited duration that is provided in an inpatient hospital setting to diagnose and treat an injury or a short-term illness
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Ambulatory care
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Preventative or corrective healthcare services provided on a nonresident basis in a provider’s office, clinic setting, or hospital outpatient setting
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American Association of Medical Colleges (AAMC)
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The organization established in 1876 to standardize the curriculum for medical schools in the United States and to promote the licensure of physicians
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American College of Healthcare Executives (ACHE)
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The national professional organization of healthcare administrators that provides certification services for its members and promotes excellence in the field
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American College of Surgeons (ACS)
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The scientific and educational association of surgeons formed to improve the quality of surgical care by setting high standards for surgical education and practice
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American Health Information Management Association (AHIMA)
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The professional membership organization for managers of health record services and healthcare information.
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American Hospital Association (AHA)
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Today, the mission of the AHA is to advance the health of individuals and communities. The association has a current membership of approximately 5,000 hospitals and healthcare institutions, 600 associate member organizations, and 40,000 individual executives active in the healthcare field. Its headquarters are located in Chicago.
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American Medical Association (AMA)
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The national professional membership organization for physicians that distributes scientific information to its members and the public, informs members of legislation related to health and medicine, and represents the medical profession’s interests in national legislative matters
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American Nurses Association (ANA)
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The national professional membership association of nurses that works for the improvement of health standards and the availability of healthcare services, fosters high professional standards for the nursing profession, and advances the economic and general welfare of nurses
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Average length of stay (ALOS)
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The mean length of stay for hospital inpatients discharged during a given period of time
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Behavioral healthcare
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A broad array of psychiatric services provided in acute, long-term, and ambulatory care settings; includes treatment of mental disorders, chemical dependency, mental retardation, and developmental disabilities, as well as cognitive rehabilitation services
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Biotechnology
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The field devoted to applying the techniques of biochemistry, cellular biology, biophysics, and molecular biology to addressing practical issues related to human beings, agriculture, and the environment
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Blue Cross and Blue Shield Association
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The national association of state and local Blue Cross and Blue Shield plans
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Case management
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1. The ongoing, concurrent review performed by clinical professionals to ensure the necessity and effectiveness of the clinical services being provided to a patient 2. A process that integrates and coordinates patient care over time and across multiple sites and providers, especially in complex and high-cost cases 3. The process of developing a specific care plan for a patient that serves as a communication tool to improve quality of care and reduce cost
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Centers for Medicare and Medicaid Services (CMS)
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The division of the Department of Health and Human Services that is responsible for developing healthcare policy in the United States and for administering the Medicare program and the federal portion of the Medicaid program; called the Health Care Financing Administration (HCFA) prior to 2001
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Chief executive officer (CEO)
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The senior manager appointed by a governing board to direct an organization’s overall long-term strategic management
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Chief financial officer (CFO)
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The senior manager responsible for the fiscal management of an organization
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Chief information officer (CIO)
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The senior manager responsible for the overall management of information resources in an organization
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Chief operating officer (COO)
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The role responsible for managing day-to-day activities of an organization
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Clinical privileges
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The authorization granted by a healthcare organization’s governing board to a member of the medical staff that enables the physician to provide patient services in the organization within specific practice limits
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Commission on Accreditation of Health Informatics and Information Management Education (CAHIIM)
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The accrediting organization for educational programs in health informatics and information management
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Conditions of Participation
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The administrative and operational guidelines and regulations under which facilities are allowed to take part in the Medicare and Medicaid programs; published by the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services
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Continuous quality improvement (CQI)
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1. A management philosophy that emphasizes the importance of knowing and meeting customer expectations, reducing variation within processes, and relying on data to build knowledge for process improvement 2. A continuous cycle of planning, measuring, and monitoring performance and making knowledge-based improvements
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Continuum of care
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The range of healthcare services provided to patients, from routine ambulatory care to intensive acute care
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Deemed status
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An official designation indicating that a healthcare facility is in compliance with the Medicare Conditions of Participation; to qualify for deemed status, facilities must be accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association
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Evidence-based medicine
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Healthcare services based on clinical methods that have been thoroughly tested through controlled, peer-reviewed biomedical studies
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Extended care facility
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A healthcare facility licensed by applicable state or local law to offer room and board, skilled nursing by a full-time registered nurse, intermediate care, or a combination of levels on a twenty-four-hour basis over a long period of time
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Health savings accounts
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Savings accounts designed to help people save for future medical and retiree health costs on a tax-free basis, part of the 2003 Medicare bill
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Health systems agency
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An agency that promotes and provides community-based health planning services
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Hill-Burton Act
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The federal legislation enacted in 1946 as the Hospital Survey and Construction Act to authorize grants for states to construct new hospitals and, later, to modernize old ones; See Hospital Survey and Construction Act
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Integrated delivery system (IDS)
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A system that combines the financial and clinical aspects of healthcare and uses a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care
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Investor-owned hospital chain
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Group of for-profit healthcare facilities owned by stockholders
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Joint Commission
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A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
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Malpractice
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The improper or negligent treatment of a patient, as by a physician, resulting in injury, damage, or loss
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Managed care
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1. Payment method in which the third-party payer has implemented some provisions to control the costs of healthcare while maintaining quality care 2. Systematic merger of clinical, financial, and administrative processes to manage access, cost, and quality of healthcare
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Managed care organization (MCO)
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A type of healthcare organization that delivers medical care and manages all aspects of the care or the payment for care by limiting providers of care, discounting payment to providers of care, and limiting access to care
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Medicaid
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An entitlement program that oversees medical assistance for individuals and families with low incomes and limited resources; jointly funded between state and federal governments
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Medical device
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Device used by a physician for a patient that has a condition where a body part does not achieve any of its primary intended purposes such as a heart valve; can be used for life support, such as anesthesia ventilators, as well as for monitoring of patients, such as fetal monitors and other uses such as incubators
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Medical staff bylaws
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A collection of guidelines adopted by a hospital’s medical staff to govern its business conduct and the rights and responsibilities of its members
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Medical staff classifications
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Categories of clinical practice privileges assigned to individual practitioners on the basis of their qualifications
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Medicare
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A federally funded health program established in 1965 to assist with the medical care costs of Americans sixty-five years of age and older as well as other individuals entitled to Social Security benefits owing to their disabilities
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National Committee for Quality Assurance
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A private not-for-profit accreditation organization whose mission is to evaluate and report on the quality of managed care organizations in the United States
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National Institutes of Health (NIH)
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Federal agency of the Department of Health and Human Services comprising a number of institutes that carry out research and programs related to certain types of diseases, such as cancer
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National Practitioner Data Bank (NPBD)
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A data bank established by the federal government through the 1986 Health Care Quality Improvement Act that contains information on professional review actions taken against physicians and other licensed healthcare practitioners, which healthcare organizations are required to check as part of the credentialing process
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Peer review organization (PRO)
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Until 2002, a medical organization that performs a professional review of medical necessity, quality, and appropriateness of healthcare services provided to Medicare beneficiaries; now called quality improvement organization (QIO)
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Physician assistant (PA)
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A healthcare professional licensed to practice medicine with physician supervision
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Postacute care
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also called subacute care or transitional care, is a type of short-term care provided by many long-term care and rehabilitation facilities and hospitals
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Prospective payment system (PPS)
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A type of reimbursement system that is based on preset payment levels rather than actual charges billed after the service has been provided; specifically, one of several Medicare reimbursement systems based on predetermined payment rates or periods and linked to the anticipated intensity of services delivered as well as the beneficiary’s condition
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Quality improvement organization (QIO)
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An organization that performs medical peer review of Medicare and Medicaid claims, including review of validity of hospital diagnosis and procedure coding information; completeness, adequacy, and quality of care; and appropriateness of prospective payments for outlier cases and nonemergent use of the emergency room; until 2002, called peer review organization
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Reengineering
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Fundamental rethinking and radical redesign of business processes to achieve significant performance improvements
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Rehabilitation services
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Health services provided to assist patients in achieving and maintaining their optimal level of function, self-care, and independence after some type of disability
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Skilled nursing facility (SNF)
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A long-term care facility with an organized professional staff and permanent facilities (including inpatient beds) that provides continuous nursing and other health-related, psychosocial, and personal services to patients who are not in an acute phase of illness but who primarily require continued care on an inpatient basis
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Subacute care
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A type of step-down care provided after a patient is released from an acute care hospital (including nursing homes and other facilities that provide medical care, but not surgical or emergency care
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Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
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The federal legislation that modified Medicare’s retrospective reimbursement system for inpatient hospital stays by requiring implementation of diagnosis-related groups and the acute care prospective payment system
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Telehealth
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A telecommunications system that links healthcare organizations and patients from diverse geographic locations and transmits text and images for (medical) consultation and treatment; also called telemedicine
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TRICARE
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The federal healthcare program that provides coverage for the dependents of armed forces personnel and for retirees receiving care outside military treatment facilities in which the federal government pays a percentage of the cost; formerly known as Civilian Health and Medical Program of the Uniformed Services
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Utilization Review Act
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The federal legislation that requires hospitals to conduct continued-stay reviews for Medicare and Medicaid patients
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Workers’ compensation
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The medical and income insurance coverage for certain employees in unusually hazardous jobs
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