Author: Glossary

The individual or organization responsible for placing a patient in a health care facility and ensuring that adequate care is given to that patient there. For example, a parent is usually the responsible party in the case of a child; the parent is not only responsible for the child receiving care, but also for the…

A law which requires hospitals to develop programs for asking families of deceased patients to donate the organs of the deceased for transplantation.  

A generic term for performance statements pertaining to health care professionals and providers. Report cards are being issued increasingly by health care institutions, regulatory agencies, insurers, managed care organizations, accrediting bodies and others, giving information such as health care outcomes, costs, charges, severity of illness of patients, intensity of services, institution staffing, medical staff composition,…

The degree of accuracy of results over a period of time, a number of trials, or among different observers or investigators. Also, the probability that a system will perform its function properly for a given period of time. The numerical value given to each procedure or other unit of service in a “relative value scale.”…

A person who is involved with working out the terms and details of reimbursement systems with third-party payers. Sometimes just refers to a person who prepares the statements and other materials needed to obtain reimbursement from third-party payers and insurers for services, and who maintains the related records.  

The payment to a hospital or other provider, after the fact, of an amount equal to the provider’s expenses in providing a given service or product. The current trend is away from such a “blank check” approach and toward prospective pricing, that is, toward agreement in advance as to the amount which will be paid…

Realistic goals for the individual patient with respect to (1) management of the patient’s specific health problems and (2) achievement of self-care, independence, and emotional well-being. These goals are set and stated by the attending physician for each patient at the time of admission to a rehabilitation hospital or long-term care facility (LTCF).  

A central agency where data from an institution or specific geographic area can be collected and made available for study and, in the health care field, sometimes made available for assisting in patient care management. An illustration of the latter use is in sending reminders to patients when follow-up examinations are scheduled (for example, in…

A rural hospital classified as such by the federal government, for purposes of reimbursement under the Medicare prospective payment system (PPS).  

A nonprofit public-policy organization in San Francisco, one of whose goals is to develop a new measure of the economic condition of the nation.