1280 S Governors Avenue | Dover, DE 19904

302.674.2853

Delaware Healthcare Association Glossary of Health Care Terms and Acronyms - Terms Starting with A

If you would like to recommend additions to the Delaware Healthcare Association's Glossary, send them for consideration to Yasmine Chinoy at yasmine@deha.org.

 

DISCLAIMER

The definitions listed here are intended for a general understanding of a health care term. These definitions should not be considered as the complete definition, since many are written in the simplest form to give a general understanding of the term listed.

 

Terms Starting with A:

 
 

24-Hour Coverage

In general, 24-hour coverage has been proposed as a type of health care system reform that integrates the health coverage and benefits currently offered by public and private insurance programs, state workers' compensation systems, and automobile insurance.

Access

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

Accountable Care Organization (ACO)

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.  The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

Accountable Health Plans (AHP)

Under the Managed Care Act, providers and insurance companies would be encouraged (through tax incentives) to form AHPs, similar to HMOs, PPOs, and other group practices.  Accountable health plans would compete on the basis of offering high-quality, low-cost care and would offer insurance and health care as a single product.  They would be responsible for looking after the total health of members and reporting medical outcomes in accordance with Federal guidelines.

Accreditation

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

Accredited

To meet the standards set by a non-governmental, state or national peer group.

Accrete

The addition of new enrollee to a health plan, usually used in reference to Medicare.

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.

Actual Charge

The amount a physician or other provider actually bills a patient for a particular medical service, procedure or supply in a specific instance.  The actual charge may differ from the usual, customary, prevailing, and/or reasonable charge.

Actuarial Analysis

The statistical calculations used to determine the managed care company's rates and premiums charged their customers based on projections of utilization and cost for a defined population.

Actuarial Cost of Coverage

The expected dollar value of a health plan's benefits.  The method of determining this value may be based entirely on a plan's provisions, or may adjust for the geographic location and demographic characteristics of enrollees, the actual health care utilization level by plan participants, or the type of plan under which the benefits are provided.

Actuarial Soundness

The requirement that the development of capitation rates meet common actuarial principles and rules.

Actuary

A person in the insurance field who decides policy rates and conducts various other statistical studies.

Acute Care

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

Acute Care Bed Need Methodology

A formula used to determine hospital bed needs.

Additional Drug Benefit List

See drug maintenance list.

Adjusted Average Per Capita Cost (AAPCC)

A county-level estimate of the average cost incurred by Medicare for each beneficiary in the fee-for-service system.

Adjusted Community Rating

Community rating impacted by group specific demographics.

Adjusted Payment Rate (APR)

The Medicare capitated payment to risk-contract HMOs.  For a given plan, the APR is determined by adjusted county-level AAPCCs to reflect the relative risks of the plan's enrollees.

Administration on Aging (AoA)

The AoA is the principal Federal agency responsible for programs authorized under the Older Americans Act of 1965.  The AoA serves as an advocate for older persons at the national level, advises Congress and Federal agencies on the characteristics and needs of older people, and develops programs designed to promote the health and well-being of the older population.  AoA provides advice, funding, and assistance to achieve community-based systems of comprehensive social services for older people.

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.

Administrative Costs Savings

Reductions in expenditures related to changes in the administrative costs associated with the provision of health care coverage and services.

Administrative Loading

The amount added to the prospective actuarial cost of the health care services (pure premium) for administrative, marketing expenses and profit.

Administrative Reform

Reducing paperwork though simplified universal forms or electronic filing and processing of claims

Administrative Services Only

An agency that delivers administrative services to an employer group.  This type of arrangement usually requires the employer to be at risk for the cost of health care services provided.

Administrative Services Organization (ASO)

An entity which only provides administrative services (including claims adjudication, member services, and management information reporting).

Admissions/1000 (APT)

The number of hospital admissions per 1,000 health plan members during a given period.

Adult Day Care

A program of social and health-related services provided during the day in a community group setting. The purpose of the program is to support frail or impaired elderly, or other disabled adults who can benefit from care in a group setting outside the home.

Adult Foster Care (AFC)

An elderly person's placement with another family when independent living is no longer possible, but nursing care is not necessary.  Also see family rest residential.

Adult Protective Services (APS)

Social service interventions for impaired adults at risk of abuse, neglect or exploitation.

Advance Directive

A document that patients complete to direct their medical care when they are unable to communicate their own wishes due to a medical condition.

Advanced Medical Directive

Advanced Nurse Care Practitioner (ANCP)

Advanced Practice Nurse

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 for all RNs. 

Adverse Selection

Among applicants for a given group or individual health insurance program, the tendency for those with an impaired health status, or 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.

Age/Sex Factor

A measurement used in insurance underwriting.  It represents the age and sex risk of medical costs of one population relative to another.  For example, a group with an age/sex factor of 1.05 would be expected to incur medical costs 5% greater than the average.

Age/Sex Rates

Set of rates for a grouping based on age and sex categories used to calculate premiums.  This type of premium structure is often preferred over single and family rating in small groups because it automatically adjusts to demographic changes in the group.  Also called table rates.

Agency for Health Care Policy and Research (AHCPR)

A Federal agency within the Public Health Service responsible for research on quality, appropriateness, effectiveness and cost of health care.

Aging in Place

Process allowing seniors to remain in their current residence despite changes in their needs by adjusting the degree and type of services provided.  This can occur at home or in a facility offering multiple levels of care..

Aging Network

A highly complex and differentiated system of Federal, State, and local agencies, organizations and institutions which are responsible for serving and/or representing the needs of older persons.  The network is involved in service systems development, advocacy, planning, research, coordination, policy development, training and education, administration, and direct service provision.  The core structures in the network include the Administration on Aging (AoA), State Units on Aging (SUA), Area Agencies on Aging (AAA), and local service provider agencies.

Aid to Families with Dependent Children (AFCD)

A Federally supported, state-administered program established by the Social Security Act of 1935 that provides financial support for children under the age of 18 (and their caretakers) who have been deprived of parental support or care because of the parent's death, continued absence from the home, unemployment, or physical or mental illness.

Alien Insurance Company

An insurance company that operates under the laws of another country.

All Patient Diagnosis Related Groups (APDRG)

An enhancement of the original Diagnostic Related Groups, designed to apply to a population broader than that of Medicare beneficiaries, who are predominately older individuals.  The APDRG set includes groupings for pediatric and maternity cases as well as of services for HIV-related conditions and other special cases.

All Payer System

A plan to impose uniform prices on medical services, regardless of who's paying.

Allied Health

General term referring to a variety of non-physician and non-nursing clinicians, practitioners, therapists, technologists and technicians working in the health field.

Allied Health Personnel or Allied Health Professional

Specially trained and often licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists, and nurses.  The term is sometimes used synonymously with paramedical personal, 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 treats disease by inducing effects opposite to those produced by the disease. The other school of medicine is osteopathic.

Allowable Charge

Generic term referring to the maximum fee that a third party will use in determining reimbursement for a given service or supply.  An allowable charge may not always be the same as the actual charge.

Allowable Costs

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

Alternative Delivery and Financing System (ADFS)

Alternative Delivery Site

Substitute for traditional inpatient sites for care such as ambulatory care centers, surgicenters, home care, hospice care, or alternative delivery and financing systems such as health maintenance organizations (HMOs), or preferred provider arrangements.

Alternative Delivery System (ADS)

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

Also used as an expression to describe all forms of health care delivery systems other than traditional fee-for-service indemnity health care.

Alternative Levels of Care

Alternatives to traditional acute impatient care, such as ambulatory care centers, surgicenters, home care, skilled nursing facilities, and hospices.

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

Ambulatory

Able to get from one place to another independently (even if using assistive devices such as manual wheelchairs, canes or walkers).

Ambulatory Care

Care given to patients who do not require overnight hospitalization.

Ambulatory Patient Group (APGS)

A payment system that pays a fixed price for certain types of outpatient procedures.

Ambulatory Setting

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

Ambulatory Surgical Center (ASC)

Freestanding centers that perform surgeries which do not require an overnight stay.

Ambulatory Utilization Management

Review prior to service against established standards to determine the medical necessity and appropriateness of the care to be provided in an ambulatory setting.  The selection of treatment plans subject to pre-service review may be based upon criteria such as proposed care that would require frequent visits, expensive therapy, an extended course of therapy, or costly technology.  Concurrent review would be applied as appropriate.

Amendments

See rider.

American Accreditation Healthcare Commission (AAHC)/URAC

Formerly known as the Utilization Review Accreditation Commission, AAHC/URAC is an independent not-for-profit corporation which develops national standards for utilization review and managed care organizations.

American Association of Homes and Services for the Aging (AAHSA)

See LeadingAge.

American College of Healthcare Executives (ACHE)

An international professional society of nearly 30,000 healthcare executives.  ACHE is known for it’s prestigious credentialing and educational programs.  ACHE is also known for its journal and magazines as well as groundbreaking research and career development and public policy programs.  ACHE'’ publishing division is a major publisher of books and journals on all aspects of health services management in addition to textbooks for use in college and university courses.  Through its efforts, ACHE works toward its goal of improving the health status of society by advancing healthcare management excellence.  ACHE headquarters is based in Chicago, IL.

American Health Care Association (AHCA)

A trade association representing nursing homes and long term care facilities in the United States; based in Washington, D.C.

American Hospital Association (AHA)

A national association that represents allopathic and osteopathic hospitals in the United States; based in Washington, D.C. with operational offices in Chicago.

American Medical Association (AMA)

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

Americans with Disabilities Act (ADA)

A Federal law which 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.

Amount, Duration, and Scope

How a Medicaid benefit is defined and limited in a state's Medicaid plan.  Each state defines these parameters, thus state Medicaid plans vary in what is actually covered.

Ancillary Care

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

Ancillary Charge

Also referred to as hospital "extras" or miscellaneous hospital charges.  They are supplementary to a hospital's daily room and board charge.  They include such items as charges for drugs, medicines and dressings; laboratory services; x-ray examinations; and use of the operating room.

Anti-Kickback Statute

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

Antitrust

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

Any Willing Provider

A term used to describe legislation that requires 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 Charge

The maximum fee Medicare will pay in a given area for a covered service.

Approved Health Care Facility or Program

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

Area Agency on Aging (AAA)

A public or private nonprofit organization designated by the state to develop and administer the area plan on aging within a sub-state geographic planning and service area.  AAAs advocate on behalf of older people within the area and develop community-based plans for services to meet their needs.  AAAs administer Federal, State, local and private funds through contracts with local service providers.  In Delaware the State Unit on Aging also services as the state's sole Area Agency on Aging.

Asset

Medicaid term referring to resources such as savings, stocks, bonds, and certain possessions that are considered in determining financial eligibility.

Assignment of Benefits

A method under which a claimant requests that his/her benefits under a claim be paid to some designated person or institution, usually a physician or hospital.

Assisted Living Facility (ALF)

Home-like residential option that provides personal care and scheduled nursing care as needed.

Assistive Devices or Technology

Any tools that are designed, fabricated, and/or adapted to assist a person in performing a particular task, e.g., cane, walker, shower chair, computer speech recognition, communication device.

Associate Degree in Nursing (AND)

A degree received after completing a two-year nursing education program at a college or university.

At-Risk

Having to assume the financial liability for a loss that occurs when premiums paid are less than the cost of services provided.

Attendant

Term used most often by the disability community to refer to an aide who provides personal assistance in the community.  Also see personal care.

Attrition Rate

Disenrollment or fall-out rate expressed as a percentage of total membership.  Off-open enrollment terminations are generally due to subscriber's employment or relocation outside of the MCO's service area, and cannot be controlled.  Open enrollment terminations are sometimes due to subscriber dissatisfaction and thus may be controllable.

Audiologist

Performs duties directly related to problems and disorders of human communication in the process of speech and hearing.

Audit of Provider Treatment

Review of the patient's medical record and charges and claims for services to assure that the services provided were consistent with the patient's diagnosis(es) and that documentation in the medical record supports the submitted charges.

Authorization

As it applies to managed care, authorization is the approval of care, such as hospitalization.  Pre-authorization may be required before a patient is admitted or care is given by (or reimbursed to) non-HMO providers.

Auto-Assignment

A term used with Medicaid mandatory managed care enrollment plans.  Medicaid recipients who do not specify their choice for a contracted plan within a specified time frame are assigned to a plan by the state.  Can also refer to assignment to primary care physicians.

Average Adjusted Per Capita Cost (AAPCC)

Payment rates used by the Centers for Medicare and Medicaid (CMS) to reimburse managed care organizations for care delivered to Medicare enrollees.

Average Cost (or Average Benefit)

The average cost (or benefit) for a unit of output (e.g., one day in a hospital for one patient) is the total cost (or benefit) of the total units of output delivered by the total units of output.

Average Length of Stay (ALOS)

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

© 2012 Delaware Healthcare Association
1280 S Governors Avenue
Dover, DE 19904
302.674.2853