Professional Documents
Culture Documents
JULY 2002
OF H EALTHCARE T ERMS & A BBREVIATIONS
H ospitals rely greatly on the talents and expertise of groups of individuals who
donate their time to the hospital. These individuals, serving as hospital trustee,
auxiliary leader, or other volunteer, while usually not professionally educated in
the field of healthcare, are often called on to discuss healthcare issues. The Glossary of
Healthcare Terms and Abbreviations, a project of the NJHA Council on Hospital Governance,
is designed to help these individuals understand the everyday language of healthcare.
T he language of healthcare has changed drastically over the past two decades. The
NJHA Council on Governance’s first glossary, for example, was called Glossary of
HOSPITAL Terms and Abbreviations. Now, titled the Glossary of HEALTHCARE Terms
and Abbreviations, it reflects hospitals’ movement beyond their own four walls. At one time,
the language of healthcare was almost exclusively within the medical domain. Now, one must
also be fluent in the language of business, finance and computer technology.
The Glossary is designed as an easy-to-use reference. Users of the Glossary will find words
and terms dealing with medicine, finance, insurance and the computer world. It is not an all-
inclusive healthcare dictionary, but rather a glossary of words, terms and abbreviations
commonly used by professionals involved in New Jersey’s hospital and healthcare industry.
The first section of the Glossary includes definitions of words and terms, defined within the
context of the healthcare world. Any commonly used abbreviations or acronyms for the
words and terms are provided. A list of frequently used general healthcare abbreviations and
or acronyms comprise the second section.
Future revisions of the Glossary will be published as needed. It is through such revisions that
the Council on Hospital Governance will continue to help non-healthcare professionals
participate in meaningful healthcare dialogue.
The Council on Hospital Governance gratefully acknowledges the expertise and assistance of
NJHA staff in the development of the original and revised edition of the Glossary.
Accounts Receivable Assets arising from services provided or the sales of goods to
patients on credit
Average Adjusted Per The formula used for determining Medicare reimbursement
Capita Cost (AAPCC) for managed care. The formula is 95 percent of Medicare Part
A and B costs per person by county.
Bundled Billing The practice of charging an all-inclusive package price for all
medical services associated with selected procedures.
Capital Formation Methods for obtaining and accumulating funds for capital
needs.
Catchment Area Geographic area defined and served by a hospital and delin-
eated on the basis of such factors as population distribution,
natural geographic boundaries or transportation accessibility.
Charity Care Free medical care rendered to individuals who do not have the
ability to pay for such care.
Chat Bulletin Board Methods used on the Internet for groups of like-minded
ListServ and/or individuals to talk to each other.
Chief Of Staff The elected or appointed leader of the hospital medical staff
organization.
Claims Made Coverage A liability policy form that covers claims made against the
insured during the policy period irrespective of when the
event occurred that caused the claim to be made.
Clinical Privileges The right to provide medical or surgical care services in the
hospital, within well-defined limits, according to an individ-
ual’s professional license, education, training, experience and
current clinical competence. Hospital privileges must be
delineated individually for each practitioner by the hospital
board, based on medical staff recommendations.
Congregate Housing Housing for older adults that includes access to a variety of
support services such as laundry or linen service, meal service,
a security system, socialization opportunities or transporta-
tion. Individual apartments usually include kitchen facilities.
Continuous Quality Used by JCAHO to describe its “Agenda for Change.” The
Improvement concept at heart of the Total Quality Management philosophy
is that quality is never static, but is a constantly moving target,
constantly open to improvement.
Cost Sharing Having consumers pay a portion of the cost of their healthcare
bills or insurance premiums.
Deductible Amount of loss or expense that the insured must incur before
the insurance company will assume any liability for all or part
of the remaining cost of covered services.
Directors and Officers Protection for directors and officers of corporations against
Liability Insurance suits or Legal claims brought by stockholders or others alleg-
ing that the directors and/or officers acted improperly in some
manner in the conduct of their duties. This coverage does not
extend to dishonest acts.
Discharge Planning Discharge planning assists patients and their families in arrang-
ing services they will need after discharge from a hospital.
EMTALA Emergency Medical Treatment and Active Labor Act, also known
as COBRA Aanti-dumping” law. EMTALA requires that all
patients who come to the Emergency Department must receive
an appropriate medical screening examination regardless of
their ability to pay and must be stabilized if they are to be trans-
ferred to another facility.
Emergency Response An emergency alarm and response system designed for functionally
System impaired persons (particularly the elderly) living in the
community. The system includes an electronic communica-
tion unit that is easily activated (in the home) when there is
an emergency, a central emergency station located in a hospi-
tal or similar facility that is responsible for receiving incoming
alarms, a process of client identification and a quick response
team or mechanism.
Extended Care Unit Unit for treatment of inpatients who require convalescent,
rehabilitative or long-term skilled nursing care.
Fee For Service Method of charging patients for services or treatment in which a
provider bills for each patient encounter or treatment or service
rendered.
Fiscal Intermediary (FI) Blue Cross Plan, private insurance company, or other public or
private agency selected by healthcare providers to pay claims
under Medicare. Currently Riverbend in Tennessee is the FI for
New Jersey.
501(c)(3) The section of the tax code that defines nonprofit, charitable,
tax-exempt organizations.
Gatekeeper A term that is generally used to refer to the primary care physi-
cian who controls referrals of patients to a hospital or for
specialty care.
Going Bare The colloquial term used to describe the choice of a provider
not to be protected by malpractice or professional liability
insurance. Many hospitals prohibit this practice by requiring
medical staff members to carry insurance.
Governing Body The legal entity ultimately responsible for hospital policy,
organization, management, and quality of care. Also called
the governing board, board of trustees, commissioners or
directors. The governing body is accountable to the owner(s)
of the hospital, which may be a corporation, the community,
local government or stockholders.
Hazardous materials Materials that are harmful to humans and other living things
(HAZMAT) like radioactive, biological or chemical materials or agents.
Within a disaster preparedness plan there is often a hazardous
material plan incorporated to deal specifically with this type
of emergency. In the event of this type of emergency a hospi-
tal is required to control patient admissions through a special
entrance, decontamination, special equipment for staff,
airflow control, etc.
Health Maintenance A prepaid health plan that acts as both an insurer and a provider
Organization (HMO) of comprehensive health services. HMO subscribers pay a capi-
tated fee and are limited to the hospitals and physicians affiliated
with the HMO. (see capitation, IPA, staff model HMO and group
model HMO)
Health Promotion Education and/or other supportive services that are hospital -
Services planned and coordinated to help people to adopt healthy
behaviors, reduce health risks, increase self - care skills, use
health care services effectively and increase understanding of
medical procedures and therapeutic regimens.
Holding Company Separate entity used to hold a variety of subsidiary groups that
often perform related functions but have a distinct corporate
identity.
Home Page A document on the Internet’s World Wide Web (WWW); the
home page is usually the first screen presented and contains
information and Alinks” to the rest of the document (as well
as other home pages). The NJHA home page, for example,
links the Avisitor” to HRET educational programs, NJHA meet-
ings and other important information, as well as to NJHA
member hospitals that have their own WWW home page.
Hospice Care Care that addresses the physical, spiritual, emotional, psycho-
logical, social, financial and legal needs of the person who is
terminally ill and his or her family. Hospice care is provided
by an interdisciplinary team of professionals and volunteers in
a variety of settings, both inpatient and at home and includes
bereavement care for the family.
House Staff Aggregate body of physicians and dentists who have completed
medical or dental school and who participate in an accredited
program of post-graduate medical education sponsored by a
hospital.
Indigent Care Medical care for those who cannot afford it. (see medically
indigent, charity care, uncompensated care)
Insurance, Catastrophic Insurance that protects the insured against all or a percentage
of loss that is not covered by another insurance or pre-
payment plan or that is incurred under specified
circumstances, or insurance in excess of specified amounts or
other dollar or benefit limits.
Intermediate Care A facility that provides nursing, supervisory and supportive services
Facility to elderly or chronically ill patients who do not require the
degree of care or treatment that a skilled nursing unit is
designed to provide.
Length of Stay (LOS) Number of calendar days that elapse between an inpatient’s
admission and discharge.
Life Safety Code Standard developed and updated regularly by the National
Fire Protection Association that specifies construction and
operational conditions to minimize fire hazards and provide a
system of safety in case of fire.
Market Basket Components of the overall cost of health care used to deter-
mine the Consumer Price Index (CPI).
Medicaid A joint federal-state program which since 1966 has paid much
of the healthcare costs of certain (but not all) low-income
persons. The federal government sets certain minimum rules
and payment levels and provides some of the funding, and each
state administers the program, contributes additional funds and
may establish additional eligibility rules and benefits.
Medical Staff That body which, according to the medical staff standard of the
Organization JCAHO, “includes fully licensed physicians, and may include other
licensed individuals permitted by law and by the hospital to
provide inpatient care services independently in the hospital.”
These individuals together make up the “organized medical staff.”
Medically Indigent A person who, by current income standards, is not poor but lacks
the financial resources to afford necessary medical services.
Medically Underserved Geographic location that has insufficient health resources to meet
Area the medical needs of the resident population.
Medicare The federal health insurance program for people age 65 and over and
those with certain chronic disabilities. Medicare has two parts. Part A
(hospital insurance) pays for most inpatient hospital care and some
follow-up care. Part B (medical insurance) pays for most physicians’
services. Patients are responsible for deductibles and co-payments.
Medicare pays hospitals for patient care using a prospective pricing
system (PPS) based on diagnosis-related groups (DRGs).
Nurse Practitioner (NP) A registered professional nurse with graduate level education
in a nursing specialty (i.e., family health, pediatrics, gerontol-
ogy). In N.J., NPs are licensed by the State Board of Nursing
and are qualified to carry out expanded healthcare evaluations
and treatment plans. Also known as advanced practice nurse.
Occurrence Coverage This was once the most common type of commercial malprac-
tice insurance. It provides coverage for liability arising from
malpractice that occurred while the policy was in effect,
regardless of when the claim or potential loss is reported. For
example, if a claim is filed after an occurrence policy has
expired, but the claim alleges an act of malpractice that
occurred when the policy was in force, the occurrence policy
will cover the management and payment of the claim.
Occurrence Policy Insurance coverage is provided for all events that occur while
the policy is in force, regardless of when the claim is filed/
reported/ made.
Operating Budget A financial plan for the expected revenues and expenditures of
the day-to-day operations of the hospital.
PGY I, II, III, IV, V Post Graduate Year I, II, III, IV and V; a term used to identify a
medical school graduate’s year of post-graduate clinical training.
(Previously known as interns and residents.) (see interns, residents)
Patient Dumping The refusal to examine, treat and stabilize any person irrespec-
tive of payer/class who has an emergency medical condition, or
is in active labor or contractions once that person has been
presented at a hospital emergency room or emergency depart-
ment. (see EMTALA)
Payment Error A CMS mandated program that is carried out by the Peer Review
Prevention (PEPP) Organization (PRO) for each state. The objective of PEPP is to
reduce payment errors made under the prospective payment
system (PPS).
Personal Care Room, board and the provision of some assistance with activi-
ties of daily living (i.e., grooming, bathing, eating).
Point Of Service (POS) A type of managed care plan in which beneficiaries have the
option of choosing to obtain medical services from the
provider of their choice, or a primary physician from the
plan’s panel of physicians. There is a financial incentive to
select a primary physician from the plan’s panel.
Post Retirement Health A major component of general retirement benefits that cover
Benefits (PRHBs) healthcare cost not paid by Medicare (in part or fully). They
are provided to retirees through the employer’s group health
plan and the set of benefits varies according to eligibility, serv-
ices covered and payment.
Primary Care Physician In managed care the term refers to the physician responsible
for coordinating and managing the healthcare needs of
members, including hospitalization and specialist referrals.
Process Management Assuring the organizational processes meet quality, cost and
productivity processes means they can be defined, measures
and systematically proved.
Provider - Sponsored Healthcare systems owned and operated by providers that integrate
Organization (PSO) a wide spectrum of services and contract with various entities
on a managed care basis. Also known as a Provider Sponsored
Network (PSN).
Quality Assurance The process used to determine the quality of care, to develop
and maintain programs to keep it at an acceptable level and to
correct patterns of care that fall below that level.
Quality Improvement System that strives to prevent crises rather than manage them.
System
Regulated Medical The seven classes of waste usually derived from direct patient
Waste care or research as defined by the federal Waste Tracking Act
WASTE (RMW) and the New Jersey Waste Tracking Act (NJAC
7:26-3A.6). It does not include ordinary business and kitchen
waste nor medical waste that does not transmit disease or raise
serious aesthetic concerns if disposed of improperly.
Restricted Funds Funds that have been designated to be spent for a specific
purpose.
Safe Harbor Regulations A set of federal regulations which clarify and ease the restric-
tions of the Medicare/Medicaid Fraud & Abuse Statutes. The
regulations specify certain types of provider payment arrange-
ments that are not subject to criminal prosecution or civil
sanctions.
Same Day Surgery A hospital-based program that provides intensive medical, nurs-
ing and rehabilitation services to individuals who spend the day
at the hospital and return home in the evening and who would
need to be in the hospital where the day program is not avail-
able. Services provided are more intensive in nature than those
commonly provided by adult day care programs.
Senior Volunteer A volunteer program making particular efforts to recruit and involve
Program older adults.
Skilled Nursing Care Nursing or other rehabilitative services provided under the
direction of a physician or an approved professional. To be
reimbursed by Medicare, this care must meet Medicare stan-
dards and be delivered in a Medicare-approved facility.
Skilled Nursing A facility that provides acute medical care and continuous
Facility (SNF) nursing care services and various other health and social serv-
ices to patients who are not in the acute phase of illness but
who require primarily convalescent, rehabilitative and/or
restorative services. The care may be delivered in a freestand-
ing facility or in a unit of a hospital.
State Health Plan Required by the Health Care Cost Reduction Act of 1991, the
State Health Plan is a document, prepared by the State Health
Planning Board and the Department of Health, that is intended
to identify unmet health needs in an area by service and loca-
tion, and to serve as the basis on which all certificate of need
applications will be reviewed and approved. Although the State
Health Plan was originally given the force and effect of law, the
Legislature revised the statutes in 1992 to make the State Health
Plan only an advisory document.
State Health Established by the Health Care Cost Reduction Act of 1991,
Planning Board the State Health Planning Board serves as the planning advi-
sory board to the Department of Health. The Board is
responsible for annually preparing and revising the State
Health Plan.
Statement of Change Financial report showing liquid assets increasing and decreasing
in Fund Balance (balance of cash accounts).
Stop Loss Insurance Also known as excess risk insurance. An insurance policy
designed to reimburse a self-funded arrangement of one or
more small employers for catastrophic, excess or unexpected
expenses; neither the employees nor other individuals are
third-party beneficiaries under the policy.
Subacute Care Medical and skilled nursing services provided to patients who
are not in an acute phase of illness but require a level of care
higher than that provided in a long term care setting.
Swing Beds Unused acute care beds that can be “swung” to long-term care
beds within the same hospital.
Third-Party Payer A payer that neither gives nor receives the care (the patient
and the provider are the first two parties). Usually an insur-
ance company or government agency.
Traditional Insurance A fixed premium for a year through which the subscribers
receive medical care from their chosen provider. The health-
care provider is paid for services rendered at essentially a rate
equivalent to usual and customary fees.
Uncompensated Care Care for which the provider is not compensated. Generally,
uncompensated care includes charity care and bad debts
(uncollectible charges to patients who have the ability to pay).
(see charity care)
Uniform Bill - UB-92 Uniform billing form submitted to the N.J. Department of
Health and Senior Services. Every acute care hospital in the
state submits this data for all inpatients and all same-day
surgery patients.
Unlicensed Assistive Trained, unlicensed staff who assist professional staff in the
Personnel (UAP) delivery of patient care.
CE Continuing education
CY Calendar year
ED Emergency Department
FY Fiscal year
IV Intravenous
MD Medical Doctor
NA Nursing assistant
NP Nurse Practitioner
OP Outpatient
OR Operating room
OT Occupational therapy
PA Physician assistant
PT Physical therapy
QA Quality assurance
RN Registered Nurse
RT Respiratory Therapist/Therapy
UR Utilization review
VA Veterans Administration
WC Worker’s compensation
YTD Year-to-date