Glossary of Healthcare Terms

CHAMPUS is the former name for TRICARE.

Companies that assesses provider claims for errors and securely forwards the bill to the correct payor.

Targets whose preliminary proposal is negotiated to an engagement agreement (contract) are considered clients.

A type of benchmarking, often dependent upon the level of investment and multidisciplinary efforts across several levels of care, is utilized for continuous development and maintenance of quality healthcare, attaining targeted patient-focused outcomes, and identifying evidence-based benchmarks for best practices, among other clinical outcomes.

Clinical decision support is a technology that provides clinicians with real-time feedback about a wide-range of diagnostic and treatment related information as they are entering electronic orders.

Services provided at these sites involve the collection and examination of bodily materials for the purposes of diagnosing, preventing, treating and assessing an illness or condition.

CNSs are APRNs who demonstrate expertise in the provision of highly specialized patient care and consult.

The scientific study and application of psychology in order to understand, prevent, and alleviate psychologically caused distress or dysfunction (disability) and promote a patient's well being and personal development.

Benchmarking metrics used to measure any clinical outcome or patient treatment. Three types of indicators fall under the umbrella of clinical quality indicators (1) generic indicators, (2) disease-specific indicators, and (3) functional indicators.

A Co-Management Arrangement is formed between a hospital and a group of physicians for the purpose of the physicians providing “co-management” services for a portion of the hospital’s business, typically a service line related to the specialty of the participating physicians.

The process of using the International Classification of Diseases, Ninth Revision, Clinical Modification and the Healthcare Common Procedure Coding System to assign a numeric value to medical diagnoses, procedures and surgery, signs and symptoms of disease and ill-defined conditions, poisoning and adverse effects of drugs, and complications of surgery and medical care.

A type of psychotherapy focused on the influence of thought on feelings and actions.

A rapidly growing form of benchmarking distinguished by its development of an atmosphere that facilitates learning and sharing of knowledge.

The Department of Health and Human Services has interpreted commercially reasonable to mean that an arrangement appears to be "a sensible, prudent business agreement, from the perspective of the particular parties involved, even in the absence of any potential referrals."

Lets beneficiaries pay for regular healthcare services using health savings accounts or health reimbursement accounts. Implementing these pre-tax savings accounts into healthcare plans allow patients (or rather, consumers) to evaluate and make decisions regarding their healthcare.