Accept Assignment

A accept assignment is a provider that accepts an insurance carrier's negotiated rate as payment in full and does not balance bill the customer for amounts greater than the Usual and Customary Charge.

Account Management

Account management is the management of activities such as balance inquiry, statement balancing, transfers between the customer's accounts at the same financial institution, maintenance of personal information, etc.

Accounts Receivable (A/R) Management

A/R management is a series of accounting transactions dealing with the billing of a customer for goods and services they have ordered.

Accounts Receivable (A/R) Research

A/R research is done on a claim against a debtor, carried on open account, usually limited to debts due from the sale of goods and services.

Acute Care

Acute care is a pattern of health care in which a patient is treated for an acute (immediate and severe) episode of illness, for the subsequent treatment of injuries related to an accident or other trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually give acute care in a hospital. Unlike chronic care, acute care is often necessary for only a short time.

Advanced Beneficiary Notice (ABN)

An ABN is a notice the hospital gives Medicare patients before services are rendered, stating that Medicare will not pay for some treatment or services. The notice is given so the patient may decide whether to have the treatment and how to pay for it.

Administrative Law Judge (ALJ)

An ALJ is an official who presides at an administrative trial-type hearing to resolve a dispute between a government agency and someone affected by a decision of that agency.

Allowable

An allowable is the price that an insurance carrier considers acceptable for a specific service or item. Most insurance carriers publish their allowable yearly.

Application Hosting

Application hosting is the rental or outsourcing of business applications from an application service provider, rather than the installation of the applications internally.

Application Programming Interface (API)

An API is an interface implemented by a software program which enables it to interact with other software. It facilitates interaction between different software programs similar to the way the user interface facilitates interaction between humans and computers.

Application Service Provider (ASP)

An ASP is an organization offering computer-based services over a wide-area network in order to meet the technology requirements of companies and individuals. Data management, email messaging, credit card processing and customized applications are examples of the services offered by ASPs.

Assignments of Benefits (AOB)

An AOB is an arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital.

Assessment

An assessment is a plan of care that identifies the specific needs of the client and how those needs will be addressed by the facility.

Assessment Validation

Assessment validation refers to a process where assessors compare and evaluate against the relevant competency standard/s to ensure, validity, reliability, fairness, flexibility and effectiveness.

Authorization

An authorization is a document signed and dated by the individual who authorizes use and disclosure of protected health information for reasons other than treatment, payment or health care operations.

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Backups

A backup or the process of backing up refers to making copies of data so that these additional copies may be used to restore the original after a data loss event.

Billing

Billing is the process of sending a bill (also called an invoice or accounts receivable) to customers for goods or services.

Business Associate Agreement (BAA)

A BAA is a contract between a covered entity and a business associate that does all of the following:

1. Establishes the permitted and required uses and disclosures of personal health information (protected health information) by the business associate.
2. Provides that the business associate will use protected health information only as permitted by the contract or as required by law, use appropriate safeguards, report any disclosures not permitted by the contract, ensure that agents to whom it provides protected health information will abide by the same restrictions and conditions, make protected health information available to individuals and make its record available to U.S. Department of Health and Human Services.
3. Authorizes termination of the contract by the Department if the Department determines that there has been a violation of the contract.

Business Continuity Planning

Business continuity planning identifies the organization's exposure to internal and external threats and synthesizes hard and soft assets to provide effective prevention and recovery for the organization, while still maintaining competitive advantage and value system integrity.

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Care Coordination

Care coordination enables people with special health care needs, especially those with chronic conditions, to navigate through complex Medicaid managed care.

Case Management

Case management is the coordination of services to help meet a patient's healthcare needs, usually when the patient has a condition which requires multiple services from multiple providers.

Centers for Medicare and Medicaid Services (CMS)

CMS is a government agency that administers Medicare funds and the federal government portion of Medicaid funds.

Chart Audits

Chart audits are an examination of medical records (electronic and/or hard copy), to determine what has been done, and see if it can be done better.

Claim Status Inquiry (CSI)

CSI is a dynamic tool that allows the supplier community to electronically check the status of production claims after they have passed the front-end edits.

Claims Management

Claims management consists of advice or services in respect of claims for compensation, restitution, repayment or any other remedy for loss or damage, or in respect of some other obligation.

Clean Claim

A clean claim is a claim that is free of errors, omissions, and that meets all of the insurance carrier requirements.

Clinical

A clinical is the direct treatment and observation of disease in patients rather than experimentation or theory.

Cloud Computing

Cloud computing refers to Internet-based computing, whereby shared resources, software and information are provided to computers and other devices on-demand, like electricity.

Certificate of Medical Necessity (CMN)

A CMN is a piece of paper required by Centers for Medicare and Medicaid Services to substantiate the medical necessity of an item of durable medical equipment furnished to a Medicare beneficiary.

Connectivity Management

Connectivity management refers to the use of computer networks to link computers to one another, and provide information resources between computer systems and their final users.

Consulting

Consulting refers to the process of providing advice in a particular area of expertise.

Continuum of Care

The continuum of care is a comprehensive system of long-term care services and support system in the community, as well as in institutions. Continuum includes: community services such as senior centers; in-home care such as home-delivered meals, homemaker services, home health services, shopping assistance, personal care, chore services and friendly visiting; community-based services such as adult day care; non-institutional housing arrangements such as congregate housing, shared housing, and board and care homes; nursing homes; and acute care services.

Contract Management

Contract management refers to the ongoing monitoring and management of the provision of services in line with the agreed terms and conditions.

Customer Support

Customer support is a range of services providing assistance with technology products such as mobile phones, televisions, computers, or other electronic or mechanical goods. In general, technical support services attempt to help the user solve specific problems with a product—rather than providing training, customization, or other support services.

Customization

Customization is the personalization, involving technology, to accommodate the differences between individuals.

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Dashboards

Dashboards are the variety of indicators displayed visually, much like a car’s dashboard. This is key information easy to read to indicate areas of success and those that need improvement. Dashboards often cover clinical quality, revenue, full time employees, patient satisfaction, etc.

Data Center

The data center is a facility used to house computer systems and associated components, such as telecommunications and storage systems. It generally includes redundant or backup power supplies, redundant data communications connections, environmental controls (e.g., air conditioning, fire suppression) and security devices.

Data Conversion

Data conversion mainly deals with the conversion of information from analogue to digital form and vice versa. All types of analogue information are essential to convert in digital format for different types of image processing.

Data Maintenance

Data maintenance refers to the adding, deleting, changing and updating of binary and high level files, and the real world data associated with those files.

Data Management

Data management comprises all the disciplines related to managing data as a valuable resource.

Data Sharing

Data sharing is the way in which authorized users gain timely access to any piece of data from any computer via the web using a simple, universal set of protocols and formats.

Data Storage Management

Data storage management comprises the memory, components, devices and media that retain digital computer data used for computing for some interval of time.

Deficiency

Deficiency is the inadequacy or incompleteness; an insufficiency, especially of something essential to health.

Delivery

Delivery is the process of transporting goods.

Denial Management

Denial management refers to the management of the refusal by a third-party payer to reimburse a provider for services or a refusal to authorize payment for services prospectively.

Denial Resolution

Denial resolution is the process of settling a refusal by a third-party payer to reimburse a provider for services or a refusal to authorize payment for services prospectively.

Digital Imaging System

A digital imaging system is a system (including people, machines, methods of organization, and procedures) which provides input, storage, processing, communications, output, and control functions for digitized representations of original public records.

Disaster Recovery

Disaster recovery is the process, policies and procedures related to preparing for recovery or continuation of technology infrastructure critical to an organization after a natural or human-induced disaster.

Discharge Planning

Discharge planning is a coordinated program developed by hospitals to ensure that each patient has a plan in place at discharge for needed continuing or follow-up care. Preparation for life after rehab, including insurance and legal issues, home adaptation, and community support issues.

Durable Medical Equipment Regional Carrier (DMERC)

A DMERC is a private company that contracts with Medicare to pay bills for durable medical equipment.

Document Management

Document management is the management and control of documents with emphasis on their dynamic and transactional nature including indexing and retrieval, revision and version control, work flow and information content.

Drill-Down Reporting

Drill-down reporting is an interactive information system to let you evaluate the data collected in your application. This information system is capable of analyzing all the data according to any of the characteristics that describe the data.

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Electronic Data Interchange (EDI)

EDI is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system.

Electronic Claims

Electronic claims are claims transmitted electronically in data "packets" from the provider's computer modem to the Medicare contractor's modem over a telephone line.

Explanation of Benefits (EOB)

An EOB is a written statement to a beneficiary, from a third-party payer, after a claim has been reported, indicating the benefits and charges covered or not covered by the dental benefits plan.

Electronic Remittance Notice (ERN)

An ERN is an electronic version of a payment explanation which provides details about providers' claims payments -- and if the claims are denied, it would then contain the required explanations.

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Facility Management

Facility management is an interdisciplinary field primarily devoted to the maintenance and care of commercial or institutional buildings. A category of management that includes facility selection and acquisition, building services, information systems, communications, safety and health, physical security, and emergency preparedness.

Fiscal Intermediaries (FI)

FIs are private insurance companies that serve as the federal government's agents in the administration of the Medicare program, including the payment of claims. The name of the FI is obtained from a hospital's most recent Medicare cost report.

File Transfer Protocol (FTP) SITE

An FTP site is a network protocol used to transfer data from one computer to another through a network, such as over the Internet.

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General Ledger

A General ledger contains all of the financial accounts of a business; contains offsetting debit and credit accounts (including control accounts).

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Home Health Agency (HHA)

HHAs are agencies that offer home care services through physicians, nurses, therapists, social workers, and homemakers whom they recruit and supervise.

Health Insurance Portability and Accountability Act (HIPAA) of 1996

HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.

Home Medical Equipment (HME)

HME is a category of devices used for patients whose care is being managed from a home or other private facility managed by a nonprofessional caregiver or family member. It is often referred to as "durable" medical equipment (DME) as it is intended to withstand repeated use by non-professionals or the patient, and is appropriate for use in the home.

Home Healthcare

Home healthcare is a program for providing nursing, therapy and health-related homemaker or social services to individuals in their homes.

Hospice

Hospice is a special way of caring for people who are terminally ill and for their family. This care includes physical care and counseling.

Hospice Care

Hospice care addresses the physical, spiritual, emotional, psychological, 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.

Hosting Services

Hosting services run Internet servers, allowing organizations and individuals to serve content to the Internet.

Hot Site

A hot site is a backup site is a location where an organization can easily relocate following a disaster, such as fire, flood, terrorist threat or other disruptive event. This is an integral part of the disaster recovery plan and wider business continuity planning of an organization.

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Implementation Services

Implementation services is the realization of an application, or execution of a plan, idea, model, design, specification, standard, algorithm, or policy.

Infusion

Infusion is a process of delivering medications, fluids, or blood products into the body through the bloodstream. A needle is used to gain access through a vein, and a catheter with tubing is used to deliver the fluid.

Insurance Verification

Insurance verification is the process of obtaining verbal or written confirmation of required coverage from your insurance agent or company.

Intake

Intake is usually the first step taken by a worker when a client seeks service.  Intake is a process whereby a request for service is made by or for a person and it is then determined whether and what kind of service is to be provided.

Integrated Care Plans

An integrated care plan is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion.

Integration

Integration is the act or process of making whole or entire.

Interim Management

Interim management is the temporary provision of management resources and skills. Interim management can be seen as the short-term assignment of a proven heavyweight interim executive manager to manage a period of transition, crisis or change within an organization.

Inventory Management

Inventory management is primarily about specifying the size and placement of stocked goods. Inventory management is required at different locations within a facility or within multiple locations of a supply network to protect the regular and planned course of production against the random disturbance of running out of materials or goods.

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Long-Term Care

Long-term care refers to those services designed to provide diagnostic, preventive, therapeutic, rehabilitative, supportive and maintenance services for individuals (and their care givers) that have chronic physical and/or mental impairments; this care is provided in a variety of settings, including the home. The goal of a comprehensive long-term care system is to promote the optimal level of physical, social and psychological functioning.

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More Than Allowed Charge (MAC)

MAC refers to the difference between the billed and allowed amounts.

Medical Documentation

Medical documentation provides all the information about a specific patient that any doctor looking at a medical record would need to know to treat that patient.

Medicare

Medicare is 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).

Medication Management

Medication management is the facilitation of safe and effective use of prescription and over-the-counter drugs. 

Mobile Workforce Management

Mobile workforce management is the management of solutions on mobile device for processes such as time clocking and payroll for field workers, dispatching job orders and optimizing routes such as increasing worker productivity, improving customer service and decreasing time-to-bill.

Module

A module is a self-contained component of a system, often interchangeable, which has a well-defined interface to the other components.

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National Council of Prescription Drug Programs (NCPDP)

NCPDP, founded in 1977, is a not-for-profit, ANSI-accredited, standards development organization with over 1575 members representing virtually every sector of the pharmacy services industry. The diverse membership provides leadership and healthcare business solutions through education and standards, created using the consensus building process.

.Net Framework

.Net framework is a software framework that can be installed on computers running Microsoft Windows operating systems. It includes a large library of coded solutions to common programming problems and a virtual machine that manages the execution of programs written specifically for the framework.

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Outcome and Assessment Information Set (OASIS)

OASIS is the comprehensive set of questions that are completed by a clinician at the time a patient is admitted, re-admitted and discharged from a home health agency. The set of data items are designed to measure (and risk-adjust) patient outcomes in home health care.

Office of Inspector General (OIG)

OIG is an office that is part of Cabinet departments and independent agencies of the United States federal government as well as some state and local governments.

Order Entry

Order entry is refers to computerized relational database that, at a minimum, generates, schedules and maintains estimates, sales orders and backlogs.

Order Management

Order management is a computer software system used in a number of industries for order entry and processing.

Outcome

An outcome is the change in a patient’s status between two or more time points.

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Patient Care

Patient care refers to any person who receives medical attention, care, or treatment.

Patient Outcomes

Patient outcomes are the patient’s result or consequence of an event, a disease, a drug, a treatment, etc.

Payer

Payer is the party making a payment.

Per Diem

Per diem refers to the price charged per visit.

Physician Orders

Physician orders includes written, telephone, fax, or consultation orders for new or altered treatment. Physician Orders does NOT include standard admission orders, return admission orders, renewal orders, or clarifying orders without changes.

Point of Care (POC)

POC involves conducting and documenting tests and other services provided to patients at the bed side.

Point of Sale (POS)

POS is the location where a transaction occurs.

Post-Acute Care

Post-acute care refers to the type of care provided after a period of acute care. The function of post-acute care is to provide for the medical and emotional needs of people who are well enough to be out of a traditional hospital setting, but not well enough to return home.

Prior Authorization (PAR)

A PAR is a document from an insurance carrier that permits a provider to bill an item for a customer.

Private Duty

Private duty provides home care aides, companion care, homemaker services and may provide nursing services in the client's home or place of residence. No government monies are used for the cost of care. The most common methods for covering the cost of private duty home care is through long term care insurance benefits, out of pocket, or other types of savings arrangements.

Process Improvement

Process improvement refers to a proactive task of management aimed at continual monitoring of a process and its outcome and developing ways to enhance its future performance.

Product Management

Product management is an organizational lifecycle function within a company dealing with the planning or forecasting or marketing of a product or products at all stages of the product lifecycle.

Project Management

Project management is the discipline of planning, organizing, and managing resources to bring about the successful completion of specific project goals and objectives.

Protected Health Information (PHI)

PHI refers to any information about health status, provision of health care or payment for health care that can be linked to a specific individual.

Prospective Payment System (PPS) Billing

PPS billing is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.

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Quality Assurance

Quality assurance is 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.

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Recidivism

Recidivism is the characteristic of many diseases to recur, with a period in between of regression.

Recovery Audit Contractors (RAC)

RAC is a private contractor hired my CMSs to identify and collect improper payments in Medicare's fee-for-service program.

Request for Anticipated Payments (RAP)

RAPs are documents that are submitted for processing at the beginning of a 60-day home health episode after a physician evaluates a beneficiary’s condition and assigns him/her to a case-mix group.

Referral Management

Referral management is the process by which primary care physicians (PCPs) determine if they need to refer a member either to a specialist or for services to be performed outside the PCP's office (diagnostic tests, outpatient surgery, home health care, etc).

Referral Source

A referral source is any source that sends business to a home health provider. Examples: Doctors, Nurses, Salespersons, Newspaper Advertisements, Radio Advertisements, etc.

Rehabilitation

Rehabilitation, also known as “rehab”, is the process of assisting someone to improve and recover lost function after an event, illness or injury that has caused functional limitations.

Reimbursement

Reimbursement is the act of compensating someone for an expense.

Remittance Management

Remittance management refers to the management of letters sent by customers to suppliers, to inform suppliers that their invoice has been paid.

Remote Access

Remote access refers to communication with a data processing facility from a remote location or facility through a data link.

Report Manager

Report Manager is a Web-based report access and management tool that you use to administer a single report server instance from a remote location over an HTTP connection. You can also use Report Manager for its report viewer and navigation features. 

Resource Management

Resource management is the efficient and effective deployment for an organization's resources when they are needed.

Revenue Cycle Management

Revenue cycle management refers to the administrative duties, clinical and financial, that facilitate the collection of all revenues for the provision of care.

Role-Based Security

Role-based security is an approach to restricting system access to authorized users.

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Statement on Auditing Standards No. 70 (SAS 70)

SAS 70 is an auditing statement issued by the Auditing Standards Board. SAS 70 provides guidance to service auditors when assessing the internal controls of a service organization and issuing a service auditor’s report.

Scheduling

Scheduling is the process of deciding how to commit resources between a variety of possible tasks.

Server Clusters

Server clusters refers to a group of linked computers, working together closely thus in many respects forming a single computer.

Server Patch Management

Server patch management is the management, installation and monitoring, typically centralized, of operating system hot fixes and updates. This is a very important administrative task in terms of keeping server and desktop machines secure as well as keeping the operating systems' kept up-to-date which enables simplified support.

Solutions

A solution refers to the process of explaining or proposing an approach that aims to address specific problems and requirements, usually through the design of specific information systems or applications.

Split Billing

Split billing is the division of a bill for service into two or more parts. Bills may be split to divide work between clients, payers or for reimbursement to different service providers for a performing a shared service.

Structured Query Language (SQL) Server

SQL Server is a database computer language designed for managing data in relational database management systems (RDBMS), and originally based upon relational algebra.

Staff Training

Staff training is the activity of teaching staff better and more profitable ways of working.

Support Surfaces

Support surfaces is medical term used to describe materials such as mattresses that support people who are bed-ridden through illness. Research and development of appropriate support surfaces can alleviate some of the complications of immobility, such as bedsores and respiratory problems.

Systems Architecture

Systems architecture is the conceptual design that defines the structure and/or behavior of a system.

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Telemedicine

Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through interactive audiovisual media for the purpose of consulting, and sometimes remote medical procedures or examinations.

Testimonial

A testimonial is a written or spoken statement from a person extolling the virtue of some product.

Throughput

Throughput is the average rate of successful message delivery over a communication channel.

Total Parenteral Nutrition (TPN) Calculator

A TPN calculator provides an online assessment of intravenous total parenteral nutrition.

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Virtual Private Network (VPN)

A VPN is a network that uses a public telecommunication infrastructure, such as the Internet, to provide remote offices or individual users with secure access to their organization's network.

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Waiver

A waiver is the voluntary relinquishment or surrender of some known right or privilege.

Web Link

A Web link is a reference to a document that the reader can directly follow or that is followed automatically.

Webinars

Webinars are used to conduct live meetings, training or presentations via the Internet from the speaker to the audience with limited audience interaction.

Workflow

Workflow is the flow or amount of work to and from an office, department, or employee.

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