Often these services are provided in a doctors office, hospital or clinic. To help unravel a bit of the complexity, nciom has compiled a list of health care terms and their definitions. Health care glossary north carolina institute of medicine. Medicaid managed care enrollment, only, including the medicaid expansion enrollment. Most states do not have specific laws guiding transgender care for adolescents. Health maintenance organization hmo health insurance policy type that arranges managed care for providers on a prepaid basis.
These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. The international glossary on infertility and fertility care. Mhs health care glossary health protection condition level hpcon level reference center sidebar navigation. Dsmiv diagnostic and statistical manual of mental disorders, 4th edition. This includes medication errors, adverse drug reactions, allergic reactions, and overdoses. Health care glossary for affordable care act aca accountable care organization aco these organizations coordinate and provide the full range of health care services for you. Appeal the process of requesting a provider or health plan pay for a service for which payment has been denied autoenrollment the automatic assignment of a person to a health insurance plan broker a salesperson that has obtained a state license to sell and service health plan and insurer contracts claim a request by an individual that his or her. The cycle ii proposal summary for the california department of managed health care was corrected on september 22, 2011. April 3, 2018 health insurance exchanges 2018 open enrollment report. Pdf concepts and definitions of health and healthrelated values. The amount can vary by the type of covered health care service. The 2017 healthy bexar plan represents the culmination of this collaborative process where partners worked together cohesively to plan how to address the needs of our community.
Health care glossary understanding health insurance isnt always easy, especially when you add industry jargon and acronyms on top of it. Recognizing the importance of timely and accurate information in the current situation, and in support of local emergency response efforts, wkc has created a special webpage to provide who official information on covid19 translated into the japanese language, including general information for the public, technical guidance for government officials and health care workers, and an explanation. A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of patient care. A total of 639 defendants were convicted of health care fraudrelated crimes during the year. Glossary of healthcare terms health insurance and reform. Open enrollment for 2018 runs from november 1, 2017 to december 15, 2017. The metric grievance resolution by type formally figure 81 was removed from this dashboard due to a change in the source data. Glossary of health coverage and medical terms ksb hospital. 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. Copies of the original, signed version of these documents are available by contacting the company licensing division of the pennsylvania insurance department. Explanatory glossary of paediatric disability terms to. Your share of the costs of a covered health care service, calculated as a.
Statetostate details the important role health plans play in all. Health care is a complex web of providers, payers, regulations, and legislation. This glossary is intended for educational purposes and may differ from the terms used in your insurance planpolicy. Call 8665578751 or visit us at if you arent clear about any of the underlined terms used in this form, see the glossary. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The following is a glossary of health insurance terms that may help answer your questions.
Glossary term definition references adverse effect adverse drug event an injury resulting from medical intervention related to a drug. Also in fy 2017, doj opened 948 new civil health care fraud investigations and had 1,086 civil health care fraud matters pending at the end of the fiscal year. Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The structure of the indicators based on hospital administrative data generally consists of definitions based. The international glossary on infertility and fertility care, 2017 fernando zegershochschild,a g. Terminology services are a fundamental piece for health data management in health. The oecd health care quality indicators hcqi are measures of health care quality that make use of readily available national hospital inpatient administrative data and other data sources. Health care services that your health insurance or plan doesnt pay for or cover. Definitions for health care quality indicators oecd. Medical managed care performance dashboard glossary released december 14, 2017 glossary page 1 of 3 percentage metrics are displayed as whole numbers. A complaint that you communicate to your health insurer or plan. Our comprehensive, easytouse glossary provides definitions for common health insurance terms to help you better understand your health care. The term sometimes is used synonymously with paramedical personnel, all health workers who perform tasks that must ot herwise be performed by a physician.
Most hmo policies do not allow a member to go outside of their network. Before any treatment is undertaken, the patient must display eligibility and readiness table 1, meaning that the adolescent has been evaluated by a mental health professional, has no contraindications to therapy, and displays an understanding of the risks involved 1. This glossary defines commonly used health insurance and health care terms. Ambulatory services health services provided to members who are not confined to a health care institution. Health care quality and patient safety, office of disease prevention and health promotion, u. Glossary of lgbt terms for health care teams as a provider in a health center or other health care organization, becoming familiar with terms used by lesbian, gay, bisexual, transgender lgbt communities can help you provide these patients with the highest quality care. Copayment a flatdollar amount which a patient must pay when visiting a health care provider. Health promotion glossary world health organization. Explanatory glossary of paediatric disability terms to support data collection by paediatricians at the point of clinical care includes guidance for considering personcentred outcomes and actions for education, health and care planning author. Your share of costs for services that a plan covers that you must pay out of your own pocket sometimes called outofpocket costs. Similarly, if you move to a nursing home, an assisted living facility or a enroll in an adult day health care program, or receive care services in your home, these are all examples of postacute care. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. The international glossary on infertility and fertility.
These are not official documents, and are provided for informational purposes only. A list of acronyms and glossary terms likely to be found within department of health doh information. This program is funded by state and federal dollars. To view pdf files on this website you need the free adobe reader. Review process and methodology of the international glossary on. The health care world is full of terms and acronyms that can often be confusing and hard to understand. The definition of clinical governance that underpins. Glossary of healthcare terms health insurance and reform accountable care organization aco.
Below is a list of words and meanings that you may come across as you use your cchp health plan. National model clinical governance framework australian. Health care is no longer viewed as a series of separate events. Pdf on dec 31, 2017, anna lydia svalastog and others published concepts and definitions of health and healthrelated values in the. Health care ahca american health care association nonprofit federation of affiliated state health organizations ahca american health care act aka trumpcare aca affordable care act aka obamacare aaahc accreditation association for ambulatory health care beneficiary health insurance plan enrollee who, along with. Jennifer piscitelli mba, cce and kelli vasquez lcsw. Today we recognize that these events are both closely tied together and integral to a persons full recovery. Some terms may have multiple and varying definitions based on the context and primary source of authority. Adult nursing is a bayada home health care specialty practical nurses at home for adults and seniors dealing with primarily on an ongoing shift basis home health care glossary this glossary is to help our home health care community better understand the terms used in relation to care. Some terms may have multiple and varying definitions based. Military health system mhs health care glossary serves as the official repository and consolidated reference as a secondary source for terms and definitions used within the mhs. Guide to national public health department accreditation version 1.
Innetwork copayments usually are less than outofnetwork copayments. A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically. This committee opinion was developed by the american college of obstetricians and gynecologists committee on adolescent health care in collaboration with committee members nancy sokkary, md, and veronica gomezlobo, md. A benefit your employer, union or other group sponsor provides to you to pay for your health care services. With new terms being created through the aca, it can be difficult to keep track of everything. The department of health and human services and the.
Thus, indicator and glossary definitions using these terms should be read. Examples of services include tests and office visits. Definitions of health insurance terms in february 2002, the federal governments interdepartmental committee on employmentbased health insurance surveys approved the following set of definitions. The first edition of this health promotion glossary of terms was published by who in 1986 as a guide to readers of who documents and publications. Managed care is a health care system in which the health care provider, in return for a fixed fee per year from a health plan, manages the care of the individual, including decisions about whether a specialist is required. Healthier washington glossary of terms 5 go to top of a to z menu. Karen horridge, disability paediatrician, sunderland chair, british academy of childhood disability. A preferred provider may not balance bill you for covered services. In the past, a trip to the hospital and a stay at a rehab facility were considered two events.
Health care glossary childrens community health plan. Please input only numbers, letters, or special characters. If you or a family member enrolled in a qualified health plan through a health insurance marketplace, the health insurance marketplace will report. This indicator is a ratio of two mortality rates and aims to account for the excess mortality from all causes in people who have a diagnosis of severe mental illnesses smi. Now that youre signed up, well send you deadline reminders, plus tips about how to get enrolled, stay enrolled, and get the most from your health insurance. Coinsurance a percentage of a health care providers charge for which the patient is financially responsible under the terms of the policy. To help you navigate through this new health care environment, weve. Some documents are presented in portable document format pdf. The cancer care team may include any or all of the specialists listed. Health care in the united states has been paid for using a feeforservice approach.
The oecd health care quality indicators hcqi are measures of health care quality that make use of. Pdf march 15, 2017 health insurance exchanges 2017 open enrollment report. Some examples of cost sharing are copayments, deductibles, and coinsurance. In this glossary, you will find some of the most common terms, with explanations that can turn you into a health care expert. The revision process of the glossary since 2006 is described in fig. Glossary and definitions of terms related to the health care survey of dod beneficiaries. If you need to spend a few days in a rehab facility after surgery, that would be postacute care. A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. Review process and methodology of the international glossary on infertility and fertility care, 2017. Learn more about the penalty for not having coverage. This glossary of health insurance and healthcare terms defines commonly used terms, is intended for educational purposes and may differ from language used in your policy.
This report catalogues what health plans contribute in terms of. As regards as the coding tool, manual coding versus computerized coding. If you did not have health coverage in 2017 and dont qualify for a health coverage exemption, you may have to pay a penalty when you file your federal tax return. If you arent clear about any of the bolded terms used in this form, see the glossary. Medigap covered lives included the sum of enrollment numbers reported to naic and in the case of california, the enrollment numbers reported to the california department of managed health care. See if you qualify for a special enrollment period. And with the additional terms that come with the affordable care act, it can seem even more confusing. Individual income tax return pdf and form 1040 instructions pdf. Glossary of health coverage and medical terms omb control numbers 15452229, 12100147, and 09381146 page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health. Health care glossary with health insurance coverage, there are many terms that can be difficult to understand.
The services may provided at a hospital or a freestanding facility. This glossary is intended for educational purposes and may differ from the. Please be sure to read the disclaimer located on the cover page of this document november 2017 glossary of terms disclaimer. Medical managed care performance dashboard glossary.
Health care services that help a person keep, learn or. Acronyms and glossary of terms public health accreditation. Whos primary role is to direct international health within the united nations system and to lead partners in global health responses. Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. The aca provides incentives for providers who join together to form such organizations and who agree to be accountable for the quality, cost, and overall care of. Medical is a california health coverage program for lowincome families. This international glossary on infertility and fertility care, 2017, is a consensus revision to harmonize clinical practice and research, and to inform patients and policy.
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