Term
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Definition
| a HEALTH CARE FACILITY THAT PROVIDES CONTINOUS PROFESSIONAL MEDICAL CARE TO PATIENTS WITH ACUTE CONDITIONS OR ILLINESSES |
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Term
| Administrative Simplification |
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Definition
| A part of HIPAA that requires the health care industry to use certain standards for the electronic exchange of health care data to protect confidentiality of patient's records. |
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Term
| ambulatory surgical center (ASC) |
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Definition
| a health care facility providing surgical services only on an outpatient basis |
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Term
| Centers for Medicare and Medicaid services (CMS) |
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Definition
| FEDRAL AGENCY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT RUNS MEDICARE, MEDICAID, CLINICAL LABOATORIES, AND OTHER GOVERNMENTAL HEALTH PROGRAMS.FORMALY KNOWN AS THE HEALTH CARE FINANCING ADMINISTARTION (HCFA) |
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Term
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Definition
| The portion of charges that an insured person must pay for health care services after payment of the deductible amount; usually stated as a percentage |
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Term
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Definition
| Anamount that an insured person must pay for each health care service encounter |
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Term
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Definition
| The nethod Medicare initially used to pay health care facilities for services furnished to beneficiaries. Payment was based on providers cost as reported annually |
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Term
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Definition
| A health plan, a health care clearing house, or a health care provider who tarnsmit s any health information in electronic form in connection with HIPAA transaction |
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Term
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Definition
| An amount that an insured person must pat, usually on an annual basis, for health care services before a payer's insurance payment begins |
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Term
| de-identified health information |
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Definition
| Medical data from which individual identifiers have been removed; also known as a redacted or blinded record |
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Term
| electronic data interchange (EDI) |
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Definition
| The system-to-system exchange of data in a standardized format |
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Term
| Health Insurance Portabilty and Accountability Act (HIPAA) of 1996 |
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Definition
| Federal government act that set forth guidelines for standardizing the electronic data interchange of administrative and finicial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information |
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Term
| health maintenance organization (HMO) |
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Definition
| A managed health care system in which providers agree to offer health care organization's members for fixed periodic payments from the plan; usually members must receive medical services only from the plan's providers. |
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Term
| HIPAA Electronic Health Care Transactions and Code Sets (TCS) |
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Definition
| HIPAA standards governing the electronic exchange of health information using standard formats and standard code sets |
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Term
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Definition
| Law taht regulates the use and disclosure of patients' protected health information (PHI) |
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Term
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Definition
| Security standards that require appropiate administrative, physical, and technical safeguards to protect the privacy of protected health information against unintended disclosure through breach of security |
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Term
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Definition
| Health care provider, licensed under state or local law, that provides skilled nursing and other therapeutic services, such as visiting nurse associations and hospital-based home care programs |
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Term
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Definition
| Care for the terminally il;l that empahsizes emotional support ans coping with pain and death |
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Term
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Definition
| An insurance company's agreement to reimburse a policyholder for covered losses if required payment have been made |
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Term
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Definition
| A PERSON ADMITTED TO A HEALTH CARE FACILITY FOR SERVICES THAT REQUIRE AN OVERNIGHT STAY |
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Term
| Intermediate Care Facility (ICF) |
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Definition
| A healthcare facility providing care to patients who do not require professional medical or skilled nursing services |
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Term
| Managed Care Organization (MCO) |
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Definition
| Organization offering some type of managed health care plan |
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Term
| Minimum Necessary Standard |
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Definition
| Principle that individually identifiable health information should be disclosed only to the extent neede to support the purpose of the disclosure |
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Term
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Definition
| A person who receives health care in a medical setting without an overnight admission: the lenght of a stay is generally less than 23 hours |
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Term
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Definition
| A payment method that reimburses a set rate for each inpatient day according to the case category |
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Term
| Preferred Provider Organization (PPO) |
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Definition
| A managed care network of health care providers who agree to perform services for plan members at discounted fees; usually, plan members can receive services from non-network providers for a higher cost |
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Term
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Definition
| The periodic ammount of money paid to an insurance company for an insurance plan |
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Term
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Definition
| A method of payment that sets a predetermined rate for each catergory of pateint illness or for services provided for a standard type of case |
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Term
| Protected Health Information (PHI) |
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Definition
| Idividually identifiable that is transmitted or maintained by electronic media |
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Term
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Definition
| Person or entity that supplies medical or health services and bills for or is paid for the services in the normal course of business. A provider may be a professional member of the health care taem, such as a physician, or a facility, such as a hospital or skilled nursing home. |
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Term
| Skilled Nursing Facility (SNF) |
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Definition
| A health care facility taht proves skilled nursing care and related services for patients who need nursing care of rehabilitation services. |
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Term
| Traetment, Payment, and Health Care Operations (TPO) |
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Definition
| Under HIPAA, the rule that patients' protected health information may be shared without authorization for the purposes of treatment, payment, and operations. |
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