Providers
This category of providers generally includes family medicine, internal medicine, and general pediatrics, but may include OB/GYN and Geriatricians
Primary Care Providers
Health centers approved by the federal government to provide low cost health care usually on a sliding fee basis and receive “cost based” reimbursements
Federally Qualified Health Center
Reimbursement made based on a predetermined, fixed amount; the payment amount for a particular service is derived based on the classification system of that service
Prospective Payment System
A facility for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician
Psychiatric Facility
A joint federal and state program that helps provide health care coverage for people with low incomes and limited resources
Medicaid
Includes but not limited to nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants
Mid-level providers
Federal program to increase access to primary care services in rural communities, using a team approach of physicians, nurse practitioners, physician assistants, and clinics, and must be staffed at least 50% of the time with these non-physician providers
Rural Health Clinic
A model under Medicare where groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their patients
Accountable Care Organizations
Caring for people who are terminally ill and for their family including physical care and counseling
Hospice
Insurance program administered by the federal government, for people who are aged 65 and over; and those permanently physically disabled or who have a congenital physical disability
Medicare
The backbone of health care, a profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life
Nurse
Facilities focused on providing same-day surgical care, including diagnostic and preventive procedures for patients who have already seen a provider and selected surgery as the appropriate treatment
Ambulatory Surgery Centers
A classification system that groups patients according to diagnosis, type of treatment, and other relevant criteria to set a payment rate regardless of the actual cost of care
Diagnosis-Related Groups (DRG)
A custodial, assistive or supervisory care provided to persons over a period of time in the home, assistive living, or nursing home.
Long Term Care
Costs borne directly by a patient without benefit of insurance
Out-of-pocket cost
A provider working under the direction of physicians, mid-level practitioners, and a registered nurse depending on their jurisdiction
Licensed practical nurse (LPN)
A facility providing inpatient care and related services for surgery, acute medical conditions or injuries, usually for a short term illness or condition
Acute Care Hospital
Direct and indirect costs, including normal standby costs incurred and necessary for efficient delivery of needed health care services
Allowable cost
Provides short-term relief for primary caregivers that can be can be arranged for an afternoon, days or weeks and can be provided at home, in a facility, or at an adult day center
Respite Care
Method of charging whereby a provider bills for each medical encounter or services rendered
Fee for service
A health professional most commonly employed by private services, municipal agencies, governments, hospitals, and fire departments – some are paid while others are volunteers
Emergency medical technician (EMT)
Federal designation of a facility that has fewer than 25 beds and at least 35 miles from similar facilities and receives “allowable cost” reimbursement
Critical Access Hospital
Alternative and potential replacement for fee-for-service reimbursements based on quality rather than quantity
Value Based Care
A program that allows critical access hospitals to use beds for acute care or post-hospital skilled nursing facility care
Swing Beds
An insurance product that is paid on a per member, per month basis that has a network of doctors, hospitals and other providers who have agreed to accept payment at a certain level for services provided
HMO/MCO