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North Carolina Hospital Association

2012 Guide to Healthcare Terminology & Acronyms

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North Carolina Hospital Association Healthcare Terms

A Access A patient's ability to obtain medical care. The ease of access is determined by components such as the availability of medical services and their acceptability to the patient, availability of insurance, the location of health care facilities, transportation, hours of operation, affordability and cost of care. Accountable Care Organization (ACO) A group of providers or suppliers or a network of groups, often affiliated with a hospital, that are jointly responsible for the cost and quality of health care provided to Medicare beneficiaries because they receive bonuses when they provide exceptional or low-cost care and are penalized for low-quality or high-cost care. Accreditation Approval by an authorizing agency for institutions and programs that meet or exceed a set of pre-determined standards. Participation is voluntary. Activities of daily living (ADLs) Activities performed as part of a person's daily routine of self care such as bathing, dressing, toileting, and eating. Acute care Hospital care given to patients who generally require a stay of several days that focuses on a physical or mental condition requiring immediate intervention and constant medical attention, equipment, and personnel. Administrative costs Costs related to activities such as utilization review, marketing, medical underwriting, commissions, premium collection, claims processing, insurer profit, quality assurance, and risk management for purposes of insurance. Advance directive A document that patients complete to direct their medical care when they are otherwise unable to communicate their own wishes.

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Advanced Practice Nurse (APN) A registered nurse who is approved by the Board of Nursing to practice nursing in a specified area of advanced nursing practice. APN is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all RNs. There are four types: 1) certified registered nurse anesthetist (CRNA); 2) clinical nurse specialist (CNS); 3) certified nurse practitioner (CNP); and 4), certified nurse midwife (CNM). Adverse drug event (error) Any incident in which the use of medication (drug or biologic) at any dose, a medical device, or a special nutritional product may have resulted in an adverse outcome in a patient. Adverse event An injury resulting from a medical intervention that is not due to the underlying condition of the patient. Advocacy Needs Data Initiative (ANDI) The North Carolina Hospital Association’s Advocacy Needs Data Initiative or ANDI is an online survey that collects financial and workforce advocacy-related data. Aftercare Services following hospitalization or rehabilitation, individualized for each patient's needs. Aftercare gradually phases the patient out of treatment while providing follow-up attention to prevent relapse. Affiliation A form of cooperative agreement in which organizations coordinate and integrate their activities without completely merging or consolidating. Agency for Healthcare Research and Quality (AHRQ) A federal agency within the Public Health Service responsible for research on quality, appropriateness, and cost of health care. AHRQ also centralizes access to state inpatient data. www.ahrq.gov/ AHEC The North Carolina Area Health Education Center Program. The mission of the North Carolina AHEC Program is to meet the state’s health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina. http://www.ncahec.net/

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Alliance A formal organization usually owned by shareholders/members that works on behalf of its individual members in the provision of services and products and in the promotion of activities and ventures. Allied health personnel Specially trained and often licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists, and nurses. They do not usually engage in independent practice. Examples are respiratory therapists, physical therapists, radiologic technologists, etc. Allowable costs Charges for services rendered or supplies furnished by a health provider that qualify as covered expenses for insurance purposes. Alternative delivery An alternative to traditional inpatient care, such as ambulatory care, home health care, and same-day surgery. Alternative medicine Treatment procedures that are not a usual component of mainstream medicine, often due to lack of supporting experimental data. Ambulatory care Care given to patients who do not require overnight hospitalization. Ambulatory patient group (APG) The Medicare program's prospective payment system for outpatient services and procedures. Each APG is a classified medical service or procedure. Unlike diagnosis related group (DRG) reimbursement for inpatient care, where medical events are condensed into one diagnostic related group, an outpatient visit can combine several different APGs. Ambulatory payment classification (APC) Groups or groupings of medical procedures and services used as a basis for reimbursement under the Medicare outpatient prospective payment system (OPPS). Ambulatory setting An institutional health setting in which organized health services are provided on an outpatient basis, such as a surgery center, clinic, or other outpatient facility. Ambulatory care settings also may be mobile units of service (e.g., mobile mammography, MRI).

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Ambulatory surgical facility See freestanding outpatient surgical center American College of Healthcare Executives (ACHE) An international professional society of nearly 30,000 health care executives based in Chicago. www.ache.org American Health Care Association (AHCA) A trade association representing nursing homes and long-term care facilities in the United States based in Washington, D.C. www.ahca.org American Hospital Association (AHA) A national association that represents allopathic and osteopathic hospitals in the United States based in Washington, D.C., with operational offices in Chicago. www.aha.org American Medical Association (AMA) A national association organized into local and regional societies that represent over 700,000 medical doctors in the United States. AMA is based in Chicago. www.ama-assn.org American Osteopathic Association (AOA) A national association organized into local and regional societies that represent over 43,000 osteopathic physicians in the United States. AOA is based in Chicago and also provides accreditation for hospitals and colleges of osteopathic medicine. www.aoa-net.org American Recovery and Reinvestment Act of 2009 (ARRA) A stimulus bill that was passed to primarily reserve and create jobs and promote economic recovery. Includes investments needed to increase economic efficiency by spurring technological advances in science and health.

Americans With Disabilities Act (ADA) A federal law that prohibits employers of more than 25 employees from discriminating against any individual with a disability who can perform the essential functions, with or without accommodations, of the job that the individual holds or wants. www.usdoj.gov/crt/ada/adahom1.htm Ancillary A term used to describe additional services performed related to care, such as lab work, X-ray, and anesthesia.

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Anti-kickback statute A federal law that prohibits the paying or receiving of remuneration in exchange for the referral of patients or business paid by a federal health care program. Antitrust A situation in which a single entity, such as an integrated delivery system, controls enough of the practices in any one specialty in a relevant market to have monopoly power (e.g., the power to increase prices). Associate Degree in Nursing (ADN) A two-year education program in the field of nursing. Nurses usually obtain the associate degree at a junior or community college. Average adjusted per capita cost (AAPCC) Payment rates used by the Centers for Medicare and Medicaid Services (CMS) to reimburse managed care organizations for care delivered to Medicare enrollees. Average length of stay (ALOS) A standard hospital statistic used to determine the average amount of time between admission and departure for patients in a diagnosis related group (DRG), an age group, a specific hospital, or other factors.

B Bachelor of Science in Nursing (BSN) A four-year college or university program that educates registered nurses, granting a Bachelor of Science degree upon graduation. Bad Debts An unpaid obligation by an individual who could pay for the health care service they received. Currently accepted health care accounting practices, and the challenge at the time of a patient’s admission to identify those who need care but do not have the ability to pay, tend to blur the lines between bad debt and charity care. Balance billing A provider's billing of a covered person directly for charges above the amount reimbursed by the health plan. This may or may not be allowed, depending upon the contractual arrangements between the parties.

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Balanced Budget Act of 1997 (BBA) A federal law enacted by U.S. Congress that made numerous changes to various titles of the Social Security Act, contained significant changes to the Medicare and Medicaid programs, and created a new Title XXI, the State Children's Health Insurance Program (SCHIP). It cut Medicare payments to doctors and hospitals, which were subsequently reduced. Balanced Budget Refinement Act of 1999 (BBRA) A federal law enacted by U.S. Congress that restored an estimated $17 billion to the Medicare program. Behavioral health care Mental health services, including services for alcohol and substance abuse. Bending the Curve Slowing the rate of growth in health care spending. Benchmarking A method of comparing the procedures and results of a process, system or, operation under study with a similar process, system, or operation under study that is generally recognized as outstanding. Beneficiary A person designated by an insuring organization as eligible to receive insurance benefits. Benefits Improvement and Protection Act of 2000 (BIPA) A federal law enacted by U.S. Congress that, among other provisions, restored an estimated $11.5 billion over five years to hospitals under Medicare, Medicaid, and other federal and state health care programs. Best Practices The most up-to-date patient care interventions, scientifically proven to result in the best patient outcomes and minimize patients' risk of death or complications. A superior method or innovative practice that contributes to the improved performance of an organization, usually recognized as "best" by other peer organizations. Blue Cross and Blue Shield Association (BC/BS) An organization that offers information, consultation, representation and operational services for the Blue Cross and Blue Shield plan members across the country for purposes of providing insurance benefits. www.bluecares.com

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Blue Cross Blue Shield of North Carolina (BCBSNC) North Carolina’s Blue Cross Blue Shield insurance plan. www.bcbsnc.com Board-certified A clinician who has passed the national examination in a particular field. Board certification is available for most physician specialties, as well as for many allied medical professions. Bundled payments A comprehensive payment covering the costs of all applicable services and other appropriate services furnished to an individual during an episode of care.

C Capitation (CAP) A stipulated dollar amount established to cover the cost of health care delivered for a person or group of persons. The term usually refers to a negotiated per capita rate to be paid periodically, usually monthly, to a health care provider. The provider is responsible for delivering or arranging for the delivery of all health services required by the covered person(s) under the conditions of the contract. CareLearning An online education service of more than 40 state hospital associations (including NCHA) along with the American Hospital Association (AHA) for the purpose of delivering more cost-effective education to hospitals. www.carelearning.com Care Share Health Alliance Care Share is a private/public partnership that helps develop community-based, integrated networks of healthcare for low-income and uninsured North Carolinians. www.caresharehealth.org Case manager A health care professional who monitors the allocation and coordination of a patient's overall care. Case mix index A measure of relative severity of medical conditions of a hospital's patients. Centers for Disease Control and Prevention (CDC) An agency within the U.S. Department of Health and Human Services (HHS) that serves as the central point for consolidation of disease control data, health promotion, and public health programs. CDC is based in Atlanta, Ga. www.cdc.gov

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Center for Medicare & Medicaid Innovation (CMMI) The Center for Medicare & Medicaid Innovation (the CMS Innovation Center) fosters health care transformation by finding new ways to pay for and deliver care that improve care and health while lowering costs. The Center identifies, develops, supports, and evaluates innovative models of payment and care service delivery for Medicare, Medicaid and CHIP. www.innovations.cms.gov/ Centers for Medicare and Medicaid Services (CMS) An agency within the U.S. Department of Health and Human Services (HHS) that is responsible for the administration of the Medicare and Medicaid programs. Formerly called the Health Care Financing Administration (HCFA). www.cms.gov Certificate of need (CON) North Carolina hospitals and physicians have to obtain approval from the NC Division of Health Service Regulation for activity such as constructing or modifying hospitals, purchasing certain medical equipment or providing new health care services. Charity care Health care services provided free of charge or at a substantial discount. North Carolina hospitals want their communities to know their financial assistance policies and what benefits they are providing. The hospitals have voluntarily submitted their financial assistance policies along with their community benefit reports online at www.ncha.org/issues/community-benefit. Chief Executive Officer (CEO) Principal executive leader of an organization. Chief Financial Officer (CFO) An executive leader who oversees financial operations. Chief Operating Officer (COO) An executive leader who oversees day-to-day management and internal operations. Children’s Health Insurance Program (CHIP) A state-administered program funded partly by the federal government that allows states to expand health coverage to uninsured, low-income children not eligible for Medicaid. North Carolina’s program is called NC Health Choice for Children. www.ncdhhs.gov/dma/healthchoice/ Clinical Measures Measures representing processes of care and patient outcomes widely accepted as important to quality care, consistently and accurately tracked in order to determine quality performance in a given clinical area, such as heart attack, pneumonia or hip and knee replacement.

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Clinical Guideline A treatment regime, agreed upon by consensus, which includes all the elements of care regardless of the effect on patient outcomes. Also called a clinical pathway. Clostridium difficile (C. diff) A bacterium transferred to patients mainly through the hands of health care personnel who have touched a contaminated surface or item and which causes diarrhea and more serious intestinal conditions such as colitis. Code of Federal Regulations (CFR) A publication of the federal government that consists of all regulations of federal departments and agencies. www.gpoaccess.gov/cfr/index.html Co-insurance A cost-sharing requirement under a health insurance policy in which the insured will assume a portion or percentage of the costs of covered services. After the deductible is paid, this provision obligates the subscriber to pay a certain percentage of any remaining medical bills. Community Benefit Programs or services that address community health needs — particularly those of the poor, minorities, and other underserved groups — and provide measurable improvement in health access, health status and use of health care resources. IRS definition: activities associated with community health needs assessments as well as community benefit planning and administration. Community benefit operations also include the organization’s activities associated with fund raising or grant-writing for community benefit programs.” North Carolina hospitals want their communities to know their financial assistance policies and what benefits they are providing. The hospitals have voluntarily submitted their financial assistance policies along with their community benefit reports. www.ncha.org/issues/community-benefit Community Care of NC (CCNC) The Community Care of North Carolina program is building community health networks organized and operated by community physicians, hospitals, health departments, and departments of social services. By establishing regional networks, the program is establishing the local systems that are needed to achieve long-term quality, cost, access and utilization objectives in the management of care for Medicaid recipients. www.communitycarenc.org/ Computerized physician order entry (CPOE) A system that allows physicians to write medical orders for their hospitalized patients using a clinical software application.

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Conditions of Participation (CoP) The federal regulations hospitals must comply with in order to qualify for Medicare reimbursement. Conference committee A bi-partisan committee made up of equal members from each chamber of the North Carolina General Assembly or U.S. Congress that is responsible for working out differences between House- and Senate-passed versions of a piece of legislation. Congressional Budget Office (CBO) A non-partisan office that provides U.S. Congress with cost estimates of legislative proposals and calculates estimates related to the federal budget. www.cbo.gov/ Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) The 1985 federal spending plan which included several health provisions and protections, including protection against denial of emergency medical care to patients who are unable to pay and the opportunity to extend employer insurance coverage following the termination of employment. Consumer Price Index (CPI) Widely used as an indicator of changes in the cost of living, as a measure of inflation, and as a means of studying price trends. Measures the change in cost of a constant bundle of goods and services purchased by consumers. Continuum of Care A comprehensive set of services ranging from preventive and ambulatory services to acute care to long-term and rehabilitative services. By providing continuity of care, the continuum focuses on prevention and early intervention and provides easy transition from service to service as needs change. Continuing Medical Education (CME) Provisions and procedures used by third-party payers to determine the amount payable when a claimant is covered under two or more health plans. Coordination of Benefits (COB) Provisions and procedures of insurers used to avoid duplicate payments when claims are covered by more than one insurance company. Copayment A type of cost-sharing that requires the insured or subscriber to pay a specified flat dollar amount, usually on a per-unit-of-service basis, with the third-party payer reimbursing some portion of the remaining charges.

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Core Measures Specific clinical measures that, when viewed together, permit a robust assessment of the quality of care provided in a given focus area, such as acute myocardial infarction (AMI). Cost The price a hospital must pay to provide a service, including the price of providing facilities, technology and workforce. Cost shifting A situation in which a health care provider compensates for the effect of decreased revenue from one payer by increasing charges to another payer. Coverage A person has coverage if all or part of his or her health care costs are paid either by insurance or by the government. Covered Lives People who are insured, whether by commercial insurance carriers, Medicare, or Medicaid. Covered Services Specific health care benefits, services and products a health plan or insurer will provide reimbursement for. Credentialing The process of reviewing a practitioner’s academic, clinical, and professional ability as demonstrated in the past to determine if criteria for clinical privileges are met. Critical access hospital (CAH) A federal designation under which hospitals receive cost-based reimbursement for Medicare services. Hospitals must meet certain criteria, such as size, length of stay, and proximity to other facilities. Critical Care Unit (CCU) Synonymous with intensive or special care unit. Service area of a hospital established to provide continuous intensive care to critically ill patients. Critical Pathway A treatment protocol including only the vital components or items proved to affect patient outcomes.

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D Deductible Out-of-pocket expenses that must be paid by the health insurance subscriber before the insurer will begin reimbursing the subscriber for additional medical expenses. Department of Health and Human Services (DHHS) The North Carolina Department of Health and Human Services is the largest agency in state government, responsible for ensuring the health, safety and well being of all North Carolinians, providing the human service needs for fragile populations like the mentally ill, deaf, blind and developmentally disabled, and helping poor North Carolinians achieve economic independence. The Department is divided into 30 divisions and offices. DHHS divisions and offices fall under four broad service areas - health, human services, administrative, and support functions. www.ncdhhs.gov Diagnostic related group (DRG) A classification system that groups patients by common characteristics requiring treatment. Discharge planning The evaluation of patients' health needs for appropriate care after discharge from an inpatient setting. Disproportionate share hospital (DSH) A hospital that provides care to a very high number of uninsured or underinsured patients. Diversion The routing of patients to other hospitals because an emergency room is temporarily at maximum capacity. Division of Health Service Regulation (DHSR) The mission of the Division of Health Service Regulation is to provide for the health, safety and well being of individuals through effective regulatory and remedial activities including appropriate consultation and training opportunities and by improving access to health care delivery systems through the rational allocation of needed facilities and services. www.ncdhhs.gov/dhsr/ Division of Medical Assistance (DMA) DMA manages the Medicaid and Health Choice programs. The mission of DMA is to provide access to high quality, medically necessary health care for eligible North Carolina residents through cost-effective purchasing of health care services and products. www.ncdhhs.gov/dma/

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Division of Mental Health/Developmental Disabilities/ Substance Abuse Services (DMH/DD/SAS) DMH/DD/SAS provides people with, or at risk of, mental illness, developmental disabilities and substance abuse problems and their families the necessary, prevention, intervention, treatment, services and supports they need to live successfully in communities of their choice. www.ncdhhs.gov/mhddsas/index.htm Division of Public Health (DPH) North Carolina Public Health works to promote and contribute to the highest possible level of health for the people of North Carolina. publichealth.nc.gov/ Doctor of osteopathy (DO) A licensed physician who is a graduate from an accredited school of osteopathic medicine. Do not resuscitate (DNR) An advance directive that patients may make to forego cardiopulmonary resuscitation or other resuscitative efforts. (See advance directive.) Doughnut hole A gap in prescription-drug coverage for some Medicare recipients. In 2012 these Medicare beneficiaries have no drug coverage once their medication costs exceed $2,930 until they have spent $4,700 out of their own pocket. Drug formulary A listing of prescription medications and appropriate dosages felt to be the most useful and cost effective for patient care. Health plans that have adopted a “closed, select or mandatory” formulary limit coverage to those drugs in the formulary. (The) Duke Endowment The Duke Endowment seeks to fulfill the legacy of James B. Duke by improving lives and communities in the Carolinas through higher education, health care, rural churches and children’s services. Since its inception, the Endowment has awarded nearly $2.9 billion in grants. www.dukeendowment.org/ Durable medical equipment (DME) Equipment that can stand repeated use, is primarily and customarily used to serve a medical purpose, generally is not useful to a person in the absence of illness or injury, and is appropriate for use at home, such as hospital beds, wheelchairs, and oxygen equipment.

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Durable power of attorney A document in which individuals select another person to act on their behalf in the event they become incapacitated. The document may identify specific activities, such as managing the incapacitated person's financial affairs. If the document allows the agent to make health care decisions, it must be drafted in a manner that meets statutory requirements for a "health care durable power of attorney." (See advance directive)

E Electronic Medical Records (EMR) The EMR can be defined as the legal patient record created in hospitals and ambulatory environments that is the data source for the EHR. Electronic Health Records (EHR) An EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office, to give patients, physicians and other health care providers, employers, and payers or insurers access to a patient's medical records across facilities. Emergency Department (ED) The unit in a health care facility that administers emergency medical services. Emergency Medical Services (EMS) A system of health care professionals, facilities, and equipment providing emergency care. Emergency Medical Technician (EMT) A person certified to provide pre-hospital emergency medical treatment. Emergency Medical Treatment and Labor Act (EMTALA) An act created by Congress as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. It is designed to prevent hospitals from refusing to treat patients or transferring them to “charity” or “county” hospitals because they are unable to pay or are covered by Medicare or Medicaid programs. Employee Retirement Income Security Act (ERISA) A federal law that exempts self-insured health plans from state laws governing health insurance, including contribution to risk pools, prohibitions against disease discrimination, and other state health reforms. Employer mandate A requirement that employers provide health insurance for employees, or pay a financial penalty.

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Environmental Protection Agency (EPA) A federal and state agency responsible for programs to control air, water and noise pollution, solid waste disposal and other environmental concerns. www.epa.gov Evidence-based medicine The wise and careful use of the best available scientific research and practices with proven effectiveness in daily medical decision-making, including individual clinical practice decisions, by well-trained, experienced clinicians. Evidence-based medicine that is best practice integrates best research evidence with clinical expertise and patient values. Exclusions Clauses in an insurance contract that deny coverage for select individuals, groups, locations, properties or risks.

F Failure mode effect analysis (FMEA) A systematic method of identifying and preventing problems (errors) before they occur. False Claims Act A federal law that imposes liability for treble damages and fines of $5,000 to $10,000 for knowingly submitting to the federal government a false or fraudulent claim for payment. Federal Employee Health Benefits Program (FEHBP) A government program that allows some 8 million federal employees, including members of Congress, to purchase private health insurance. The government provides a set amount of money to employees, who can select from a variety of health plans. Federal Financial Participation (FFP) The portion paid by the federal government to states for their share of expenditures for providing Medicaid services and for administering the Medicaid program and certain other human service programs. Also called federal medical assistance percentage (FMAP). Federal Fiscal Year (FFY) The federal government's accounting year, which begins Oct. 1 and ends Sept. 30 (e.g., FFY 2011 begins Oct.1, 2010, and ends Sept. 30, 2011). Federal Medical Assistance Percentage (FMAP) The share of each state's Medicaid program paid by the federal government, based on the state's per capita income.

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Federal poverty guidelines The official annual income level for poverty as defined by the federal government. Under the 2011 guidelines, the federal poverty level for a family of four is $22,350. Federal Trade Commission (FTC) A federal agency created to protect consumers against unfair methods of competition and deceptive business practices, such as sales fraud and price fixing. Investigates and applies antitrust laws. www.ftc.gov Federal Register An official publication of the federal government that provides final and proposed regulations of federal legislation. www.gpoaccess.gov/fr/index.html Federally Qualified Health Center (FQHC) A primary care clinic located in an underserved area that meets the health care needs of special populations and receives special reimbursement for doing so. Fee for service A method in which physicians and other health care providers receive a fee for services performed. Fee schedule A comprehensive listing of fees used by either a health care plan or the government to reimburse providers on a fee-for-service basis. Fellow of American College of Healthcare Executives (FACHE) The highest credential awarded by the American College of Healthcare Executives (ACHE). Fiscal intermediary The Medicare Part A claims processing contractor. North Carolina’s is Palmetto GBA. Fiscal Year (FY) Any entity's accounting year. Food and Drug Administration (FDA) An agency within the federal government that is responsible for regulations pertaining to food and drugs sold in the United States. www.fda.gov

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Freestanding emergency medical service center A health care facility, physically separate from a hospital, that provides immediate, short-term medical care for minor but urgent medical conditions. Freestanding outpatient surgical center A health care facility, physically separate from a hospital, that provides pre-scheduled, outpatient surgical services.

G General practitioner (GP) A physician whose practice is based on a broad understanding of all illnesses and who does not restrict his/her practice to any particular field of medicine. Generic Drug Pertaining to the descriptive or nontrade name of a drug or other product; for example, diazepam is the generic name for Valium. Government Accountability Office (GAO) A non-partisan investigative arm of U.S. Congress that evaluates federal programs as an oversight of federal spending, efficiency, and performance. www.gao.gov Graduate medical education (GME) Medical education as an intern, resident, or fellow after graduating from a medical school. Group insurance Any insurance policy or health services contract by which groups of employees (and often their dependents) are covered under a single policy or contract, issued by their employer or other group entity. Group Practice A formal association of three or more physicians, dentists, or other health professionals providing services, with income from the medical practice distributed to the group members according to a prearranged plan.

H Health and Humans Services (HHS) The U.S. Department of Health and Human Services (HHS) is a department within the executive branch of the federal government responsible for Social Security and federal health programs in the civilian sector. www.dhhs.gov

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Health care-acquired infection (HAI) An infection acquired by an individual while receiving care or services in a hospital or other health care facility. Health care durable power of attorney A document in which individuals select another individual to make health care decisions for them in the event they become incapacitated. A health care durable power of attorney should be distinguished from a living will, a document drafted by an individual that provides direction regarding medical care if the individual becomes incapacitated by terminal illness or permanent unconsciousness. (See "advance directive") Healthcare Failure Mode and Effect Analysis (HFMEA) A prospective assessment that identifies and improves steps in a process, thereby reasonably ensuring a safe and clinically desirable outcome. A systematic approach to identify and prevent product and process problems before they occur. Healthcare Financial Management Association (HFMA) A professional association of health care finance managers. www.hfma.org Health care system A corporate body that owns and/or manages multiple entities including hospitals, long-term care facilities, other institutional providers and programs, physician practices, and/or insurance functions. Also called health system, multihospital system, or network. Health Information Technology for Economic and Clinical Health Act (HITECH) The Health Information Technology for Economic and Clinical Health Act (HITECH) portion of the ARRA provides $17.2B in reimbursement payment incentives and $2B in competitive planning and implementation grants to states. Health insurance A contract that requires a health insurer to pay some or all of a patient’s health care costs in exchange for a premium. Health insurance exchange A government-administered marketplace or portal (website) where private or public insurance policies are sold. Health Insurance Portability and Accountability Act (HIPAA) The Health Insurance Portability and Accountability Act (HIPAA) of 1996 included a series of "administrative simplification" provisions that required the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions including

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regulations related to electronic health care transactions, health information privacy, and security requirements. Regulations have in some cases expanded the scope of HIPAA to also include non-electronic transactions. Health maintenance organization (HMO) An entity that offers prepaid, comprehensive health coverage for both hospital and physician services with specific health care providers using a fixed fee structure or capitated rates. Health Plan Employer Data and Information Set (HEDIS) A set of performance measures designed to standardize the way health plans report data to employers. HEDIS measures five major areas of health plan performance: quality, access and patient satisfaction, membership and utilization, finance, and descriptive information on health plan management. Health Resource Service Administration (HRSA) A federal agency within the U.S. Department of Health and Human Services that provides health care grant programs. www.hrsa.gov Health savings account (HSA) A tax-deductible personal savings account, usually offered by employers along with high-deductible health-insurance plans, used to pay for medical expenses. Hill-Burton Act Following World War II, the federal government encouraged the building of hospitals and other health care facilities by providing funds for expansion and development. These funds, made available through the Hill- Burton Construction Act (Titles VI and XVI of the Public Health Service [PHS] Act), spurred the development of community hospitals, nursing homes, public health centers and rehabilitation facilities. In accepting Hill- Burton funds, public and nonprofit medical facilities agreed to make services available to persons in the facilities’ service area without discrimination on the basis of race, color, national origin, creed or ability to pay for 20 years following the facilities’ completion. Hill-Burton facilities were required to participate in the Medicare and Medicaid programs and they were required to post public notice of their community service obligation. Home health agency (HHA) An organization that provides medical, therapeutic, or other health services in patients' homes. HOSPAC NCHA’s Political Action Committee. www.ncha.org/hospac

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Hospice A facility or program that is licensed, certified, or otherwise authorized by law, that provides supportive care of the terminally ill. Hospital-acquired condition (HAC) Conditions that could reasonably have been prevented through the application of evidence-based guidelines. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. www.hcahpsonline.org Hospital Incident Command System (HICS) An incident management system based on the Incident Command System that helps hospitals improve emergency management response and recovery capabilities for planned and unplanned events. Hospital market basket Components of the overall cost of health care used in determining the consumer price index. Hospital Market Basket Index An inflationary measure of the cost of goods and services purchased by health care facilities, often used to determine growth in reimbursement rates. Hospital Quality Alliance A public-private collaboration to improve the quality of care provided by U.S. hospitals by measuring and publicly reporting a set of measures. An element of the program is the Hospital Compare Web-site, which debuted April 2005 at www.hospitalcompare.hhs.gov and www.medicare.gov. Hospitalist Physician specialists in inpatient medicine who spend at least 25 percent of their professional time serving as the physicians-of- record for inpatients, returning the patients back to the care of their primary care providers at the time of hospital discharge.

I Indicator 1. A measure used to determine, over time, performance of functions, processes and outcomes. 2. A statistical value that provides an indication of the condition or direction over time of performance of a defined process or achievement of a defined outcome.

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Indigent medical care Care given by health care providers to patients who are unable to pay for it. Individual mandate A requirement that every American have health insurance, which would be enforced through financial penalties. Inpatient An individual who has been admitted to a hospital for at least 24 hours. Integrated delivery system Collaboration between physicians and hospitals for a variety of purposes. Some models of integration include physician-hospital organization, management-service organization, group practice without walls, integrated provider organization, and medical foundation. Intergovernmental Transfers (IGT) Transfers of public funds between governmental entities. The transfer may take place from one level of government to another (i.e. counties to states) or within the same level of government. Intermediate care facility A facility providing a level of medical care that is less than the degree of care and treatment that a hospital or skilled nursing facility is designed to provide but greater than the level of room and board. International Classification of Diseases (ICD) The classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations for data storage and retrieval. Provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Intensive Care Unit (ICU) The area of a hospital where patients with life-threatening illnesses are closely monitored. Also called Critical Care Unit. IRS Form 990 The tax-exempt return most charitable organizations, including hospitals, file with the IRS each year. It includes income, expenditures and activities, as well as compensation of high-level employees and lobbying expenditures and certain other activities.

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J The Joint Commission Founded in 1951 by doctors and hospitals, The Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations or JCAHO) evaluates and accredits health care organizations in the U.S., including hospitals, health plans, and other care organizations that provide home care, mental health care, laboratory, ambulatory care, and long-term services. www.jointcommission.org/ Joint Commission Resources (JCR) A subsidiary of the Joint Commission designed to distribute consulting and publication services. www.jcrinc.com

K Kate B. Reynolds Charitable Trust The Kate B. Reynolds Charitable Trust was established in 1947 with a mission to improve the quality of life and the quality of health for the financially needy of North Carolina. www.kbr.org/

L Lean manufacturing An Initiative focused on eliminating all waste in manufacturing processes. Principles of lean include zero waiting time, zero inventory, scheduling (internal customer pull instead of push system), batch to flow (cut batch sizes), line balancing and cutting actual process times. Leapfrog Group A group of Fortune 500 employers and other purchasers of health care, sponsored by the Business Roundtable, focused on patient safety issues. www.leapfroggroup.org Length of stay (LOS) The number of days a patient stays in a hospital or other health care facility. Licensed Practical Nurse (LPN) A nursing school graduate who has been licensed by a state. Life Safety Code Standards of construction, protection and occupancy necessary to minimize danger to life from fire, smoke, fumes and panic. The Joint Commission and the Centers form Medicare and Medicaid Services require compliance with the code.

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Living will A legal document generated by an individual to guide providers on the desired medical care in cases when the individual is unable to articulate his or her own wishes. (See "advance directive") Long-term care (LTC) Care given to patients with chronic illnesses who usually require a length of stay longer than 30 days. Long-term care hospital (LTCH or LTACH) A hospital that specializes in treating patients with serious and often complex medical conditions requiring a longer length of stay than customarily provided by a traditional acute care hospital. LTCHs provide care for such conditions as respiratory failure, non-healing wounds, and other diseases that are medically complex. Long-Term Care Facility (LTCF) Any residential health care facility that administers health, rehabilitative or personal services for a prolonged period of time.

M Magnet Hospital Recognition Program A designation through the American Nurses Credentialing Center that recognizes those institutions that act as a “magnet” by creating a work environment that recognizes and rewards professional nursing. www.nursecredentialing.org/Magnet.aspx Magnetic resonance imaging (MRI) A diagnostic technique that uses radio and magnetic waves, rather than radiation, to create images of body tissue and to monitor body chemistry. Malpractice The improper treatment of a patient, as by a physician or nurse, resulting in injury. Managed care A system of health care delivery that influences utilization and cost of services, and often includes a capitated payment structure and a limited choice of health care providers. Management Service Organization (MSO) A legal entity that provides practice management, administrative and support services to individual physicians or group practices. An MSO may be a direct subsidiary of a hospital, a joint venture with physicians, a physician-owned organization or an investor-owned expertise.

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Master of Science in Nursing (MSN) A person holding a master’s degree in nursing. Medicaid A state-administered health insurance program funded partly by the federal government that provides health care services for certain low-income persons and certain aged, blind or disabled individuals. Medical Board The entity that licenses physicians to practice in North Carolina and disciplines those who violate state law and rules related to medical practice. www.ncmedboard.org Medical Consumer Price Index An inflationary statistic that measures the cost of all purchased health care services. Medical doctor (MD) A licensed physician who is a graduate of an accredited school and practices allopathic medicine. Medical error The failure of a planned action to be completed as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning). Medical malpractice insurance Insurance purchased by a person or entity, such as a doctor or hospital, that pays up to the limits of the policy for damages to a patient caused by malpractice. Medical savings account (MSA) A method of financing health care by giving tax advantages to individuals who establish and maintain personal accounts for health care purposes; similar to an Individual Retirement Account for retirement purposes. Medicare A federally funded program that pays for medical services to residents over age 65 and the permanently disabled. Coverage is divided into two components. Medicare Administrative Contractor (MAC) Replaces Medicare Part A Fiscal Intermediaries (FIs) and Part B Carriers with 15 new regional Medicare provider bill payment and cost report intermediaries. North Carolina is in MAC Region 11 (J11).

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Medicare Advantage Also referred to as “Medicare Part C,” or “Medicare+Choice,” a Medicare program under which eligible Medicare enrollees can elect to receive benefits through a managed care program that places providers at risk for those benefits. Medicare Cost Reports Reports submitted by hospitals that provide services to Medicare beneficiaries. These reports are a condition of participation in the program and contain detailed hospital data, including financial statements and utilization information. Medicare Dependent A Medicare reimbursement category for a hospital that is located in a rural area, has no more than 100 beds, and has had at least 60 percent of its inpatient days or discharges attributed to Medicare.

Medicare Modernization Act of 2003 (MMA) A federal law that provided a prescription drug benefit under the Medicare program. MMA made various other adjustments to the Medicare and Medicaid programs affecting providers, including payment and regulatory improvements for hospitals. Also known as the Medicare Prescription Drug Bill.

Medicare Part A One of two parts of the Medicare program that covers inpatient hospital services and services furnished by other health care providers such as nursing homes, home health agencies, and hospices. Part A coverage is automatically provided for individuals entitled to Medicare.

Medicare Part B One of two parts of the Medicare program that covers outpatient, physician, and medical supplier services. Part B coverage is optional and must be paid for separately through monthly premium payments.

Medicare Part C A Medicare program under which eligible Medicare enrollees can elect to receive benefits through a managed care program that places providers at risk for those benefits. Medicare Part D The part of the Medicare program that covers prescription drug coverage. Since 2006, beneficiaries have had access to partial prescription drug coverage paid mainly through state payments, premiums and general revenue. Some assistance for low-income beneficiaries is available for premiums and co-pays.

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Medicare Payment Advisory Commission (MedPAC) A non-partisan congressional advisory body charged with providing policy advice and technical assistance concerning the Medicare program and other aspects of the health system. It conducts independent research, analyzes legislation, and makes recommendations to U.S. Congress. The Physician Payment Review Commission (PPRC) has been merged with the Prospective Payment Assessment Commission (ProPAC) to create MedPAC. www.medpac.gov Medigap A policy guaranteeing to pay a Medicare beneficiary’s co- insurance, deductible, and co-payments and provide additional health plan or non-Medicare coverage for services up to a predefined benefit limit. In effect, the product pays for the portion of the cost of services not covered by Medicare. Methicillin Resistant Staphylococcus Aureus (MRSA) A type of staph infection that is resistant to certain antibiotics including methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. MRSA is a hospital- and community-acquired infection that is usually manifested as a skin infection, looking like a pimple or boil, and can occur in otherwise healthy people. Morbidity Incidents of illness and accidents in a defined group of individuals. Mortality Incidents of death in a defined group of individuals. Most-favored-nation clause (MFN) A provision requiring the contracting physician, hospital, or group to provide an insurer with the lowest price it charges any other insurer.

N National Cancer Registry A unit within the National Institutes of Health (NIH) that provides updates on the latest cancer diseases, research and diagnosis. www.ncri.ie

National Center for Health Statistics (NCHS) A division within the U.S. Department of Health and Human Services that is responsible for gathering data on illness and disability, producing the vital statistics of the nation and tracking the use and availability of health services and resources. www.cdc.gov/nchs

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National Committee for Quality Assurance (NCQA) A nonprofit organization created to improve patient care quality and health plan performance in partnership with managed care plans, purchasers, consumers, and the public sector. www.ncqa.org/Pages/Main/index.htm National Incident Management System (NIMS) A standardized approach to incident management and response that establishes a uniform set of processes and procedures that emergency responders at all levels of government use to conduct response operations. There are 14 elements specific to hospitals and health care organizations. National Information Center on Health Services Research and Health Care Technology (NICHSR) A division within the U.S. Department of Health and Human Services that supports analyses and evaluations of the health care system and its financing, and underwrites the development and testing of new approaches to improve the distribution, use and cost-effectiveness of services. www.nlm.nih.gov/nichsr/ National Institutes of Health (NIH) A division within the U.S. Department of Health and Human Services that is responsible for most of the agency's medical research programs. www.nih.gov National Quality Forum (NQF) A not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. www.qualityforum.org National Provider Identifier (NPI) The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. National Rural Health Association (NRHA) A national trade association representing rural hospitals, rural health clinics and other rural health care providers. www.ruralhealthweb.org/ NCHA Strategic Partners NCHA Strategic Partners is a wholly owned subsidiary of the NC Hospital Association and is committed to being the first resource healthcare providers turn to for access to cost-effective solutions that work. www.nchastrategicpartners.org/

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Network A group of hospitals, physicians, other providers, insurers, and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Never event An event that results in death, loss of a body part, disability, or loss of bodily function lasting more than seven days or still present at the time of discharge from an inpatient health care facility. Also referred to as preventable adverse events. Nonprofit Hospital A non-taxable hospital that operates on a not-for-profit basis under the ownership and control of a private corporation. Usually owned by a community, church or other organization concerned with community services and resources, nonprofit hospitals use earnings to improve their facilities and services. North Carolina Center for Hospital Quality and Patient Safety The North Carolina Hospital Association created the North Carolina Center for Hospital Quality and Patient Safety (NC Quality Center) in 2004 to lead the state's hospitals to become the safest and highest quality hospitals in the United States. www.ncqualitycenter.org/ North Carolina Center for Rural Health Innovation and Performance The NC Center for Rural Health was created by the North Carolina Hospital Association in 1996 as a rural health resource center, providing expert technical assistance and professional consultation. The Center is dedicated to developing and spreading nation-leading improvements in performance, leadership, quality and patient safety, operational management and community health for rural hospitals and rural health organizations throughout North Carolina. www.ncha.org/ruralhealth North Carolina Hospital Association (NCHA) The North Carolina Hospital Association is statewide trade association representing more than 130 hospitals and health systems. The association promotes improved delivery of quality healthcare in North Carolina through leadership, advocacy, information and education, in its members' interest and for public benefit. www.ncha.org/ North Carolina Hospital Quality Performance Report The NC Quality Center's web-based transparent, hospital-specific performance report for North Carolinians. www.NCHospitalQuality.org/ North Carolina Institute of Medicine (NCIOM) The NC Institute of Medicine seeks constructive solutions to statewide problems that impede the improvement of health and efficient and effective delivery of healthcare for all North Carolina

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citizens. NCIOM serves an advisory function at the request of the Governor, the General Assembly, and/or agencies of state government, and to assist in the formation of public policy on complex and interrelated issues concerning health and healthcare for the people of North Carolina. www.nciom.org/ North Carolina Prevention Partners (NCPP) NC Prevention Partners is a state and national leader in guiding schools, hospitals and workplaces to improve their culture of wellness by improving policies and environments that address tobacco use, physical inactivity, poor nutrition and obesity. The Healthy NC Hospitals initiative is helping hospitals statewide establish quit-tobacco systems, healthy food and physical activity policies to make NC hospitals even healthier for employees, patients and visitors. www.ncpreventionpartners.org North Carolina Quality Center Patient Safety Organization North Carolina's first federal Patient Safety Organization (PSO) as certified by the Agency for Healthcare Research and Quality (AHRQ). The NCQC PSO conducts activities that minimize harm to patients by fostering a culture of quality and safety through learning and sharing among healthcare organizations. www.ncqualitycenter.org/pso.lasso North Carolina-Virginia Hospital Engagement Network (NoCVA) The North Carolina-Virginia Hospital Engagement Network (NoCVA HEN) is a group of 117 hospitals in North Carolina and Virginia working to meet the goals of the Partnership for Patients, a national initiative which aims to reduce patient harm by 40 percent and reduce readmissions by 20 percent. www.ncqualitycenter.org/nocva/index.lasso Nosocomial infections An infection acquired by an individual while receiving care or services in a health care organization. Nuclear Regulatory Commission (NRC) A federal commission created in 1974 to protect the public health and safety by regulating civilian uses of nuclear materials. www.nrc.gov Nurse Anesthetist A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. Nurse Midwife A registered nurse that has received special training to examine expectant mothers and perform or assist in routine labor and delivery of normal infants.

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Nurse Practitioner A registered nurse who has completed additional training beyond basic nursing education and provides primary health care services in accordance with state nurse practice laws or statutes. Nursing quality indicators A set of 10 nursing-sensitive indicators that link nursing interventions to patient outcomes.

O Occupational Safety and Health Administration (OSHA) A federal agency within the U.S. Department of Labor that is responsible for setting standards to promote and enforce employee safety in the workplace. www.osha.gov Occupational therapist (OT) A health care professional in rehabilitation who helps patients regain, develop and build skills for independent functioning. Office of the Assistant Secretary for Preparedness and Response (ASPR) The federal agency within the U.S. Department of Health and Human Services (HHS) that provides health care preparedness grants. www.hhs.gov/aspr Office of Inspector General (OIG) The enforcement arm within the U.S. Department of Health and Human Services (HHS) that oversees investigations of alleged violations of Medicare and Medicaid laws and rules. (Most federal agencies have their own OIG.) www.hhs.gov Office of Management and Budget (OMB) A federal agency responsible for providing fiscal accounting and budgeting services for the federal government. www.whitehouse.gov/omb Office of the National Coordinator for Health Information Technology (ONC) ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. Office of Professional Standard Review Organizations The health standards and quality bureau of the Centers for Medicare and Medicaid Services.

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Omnibus Budget Reconciliation Act (OBRA) An amendment to the federal budget that outlines new federally funded programs or revisions to existing programs. Operating Margin Operating margins reflect a surplus or deficit from operations. Through predominantly nonprofit in Michigan, hospitals need positive margins to replace old equipment, recruit and retain professional staff, and to demonstrate to lenders the ability to repay debt. Operating Room (OR) Hospital suite in which surgery requiring anesthesia is performed. Organ procurement organization (OPO) A non-profit, federally funded organization that aids in the organ transplantation process. ORYX The integration of performance measurement into the Joint Commission’s accreditation process. Each accredited facility must select vendors that have been approved by the Joint Commission for the performance measurement system. Osteopathic One of two schools of medicine that uses manipulative measures in treating patients in addition to the diagnostic and therapeutic measures of medicine. The other school is allopathic. Outcome measures Assessments to gauge the results of treatment for a particular disease or condition. Outcome measures include the patient's perception of restoration of function, quality of life, and functional status, as well as objective measures of mortality, morbidity, and health status. Outlier A patient case that falls outside of the established norm for diagnosis related groups. Out-of-area benefits The coverage allowed to HMO members for emergency and other situations outside of the prescribed geographic area of the HMO. Outpatient A person who receives health care services without being admitted to a hospital.

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Outpatient Prospective Payment System (OPPS) A determined payment rate for a Medicaid outpatient procedure regardless of services rendered or the intensity of the services.

P Palliative care Care for not only physical symptoms, but also for emotional, social, spiritual, psychological and cultural symptoms to achieve the best possible quality of life. Palliative care is usually provided at the end of life or to help deal with chronic conditions. Palmetto GBA Palmetto GBA, headquartered in Columbia, SC, administers the transaction process for Medicare services in North Carolina. www.palmettogba.com Participating provider A health care provider who has a contractual arrangement with a health care service contractor, HMO, PPO, IPA or other managed care organization. Patient-Centered Care Care that is respectful of and responsive to individual patient preferences, needs and values and ensures patient values guide all clinical decisions; care that is coordinated, communicative and supportive. Partnership for Patients The Partnership for Patients: Better Care, Lower Costs is a public-private partnership that will help improve the quality, safety and affordability of health care for all Americans. With funding provided by the Affordable Care Act and leveraging a number of ongoing programs, the Department of Health and Human Services will work with a wide variety of public and private partners to achieve the two core goals of this partnership – keeping patients from getting injured or sicker in the health care system and helping patients heal without complication by improving transitions from acute-care hospitals to other care settings, like home or a skilled nursing facility. Hospital Engagement Networks (HENs) will help identify solutions already working to reduce health care acquired conditions, and work to spread them to other hospitals and health care providers. www.healthcare.gov/compare/partnership-for-patients/ Patient Protection and Affordable Care Act (PPACA) The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) or informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. On June 28, 2012, the Supreme Court upheld the constitutionality of much of PPACA. ACA represents the most significant regulatory overhaul

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of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. ACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees to employers and uninsured individuals in order to increase insurance coverage. Additional reforms are aimed at improving healthcare outcomes in the United States while updating and streamlining the delivery of health care. ACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender. Patient Safety Organization (PSO) A PSO collects, aggregates and analyzes patient safety events that are confidentially reported by hospitals and other healthcare providers. By encouraging voluntary and confidential reporting of serious adverse events a PSO can facilitate a shared-learning approach that supports effective improvements to reduce risk and harm in the delivery of health care. On December 10, 2008 the NC Center for Hospital Quality & Patient Safety became North Carolina's first federal Patient Safety Organization as certified by the Agency for Healthcare Research and Quality (AHRQ). www.ncqualitycenter.org/pso.lasso Patient Self-Determination Act A federal law that requires health care facilities to determine if new patients have a living will and/or durable power of attorney for health care and take patients' wishes into consideration in developing their treatment plans. Pay for performance A new movement in health insurance where providers are rewarded for quality of health care services. Also called value-based purchasing. Payer An organization (such as the federal government for Medicare or a commercial insurance company) or person who directly reimburses health care providers for their services. Payment Reimbursement a hospital receives for care provided; usually less than the standard charge and sometimes less than the cost of providing care. Peer review Review of a health professional’s performance of clinical professional activities by peers through formally adopted written procedures. Peer Review Organization or Professional Review Organization (PRO) An organization with which the Medicare program and hospitals contract for quality and utilization review of services covered by the program.

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Performance measure A quantitative tool (for example, rate, ratio, index or percentage) that provides an indication of an organization's performance in relation to a specified process or outcome. Per member per month (PMPM) The amount of money paid or received on a monthly basis for each individual enrolled in a managed care plan, often referred to as capitation. Physician-hospital organization (PHO) A legal entity formed and owned by one or more hospitals and physician groups in order to obtain payer contracts and to further mutual interests; one type of integrated delivery system. Physical Therapist (PT) An individual trained, licensed in, or practicing physical therapy. Physician Assistant (PA) A trained, licensed individual who performs tasks that might otherwise be performed by physicians or under the direction of a supervising physician. Point-of-service (POS) An insurance plan in which members need not choose how to receive services until the time they need them, also known as an open-ended HMO. Point-of-Service Plan (POS) A model that combines features of both HMOs and traditional insurance. Enrollees decide at the time care is needed whether to use a doctor who is in the network or one who is not. Copayments and fee schedules are typically larger when a doctor outside the network is chosen. Political action committee (PAC) A group of people organized to collect and distribute contributions to political candidates. Pre-admission testing (PAT) Patient tests performed on an outpatient basis prior to admission to the hospital. Pre-existing condition An illness or other medical condition that a patient has experienced before the effective date of insurance coverage. Preferred provider organization (PPO) A panel of physicians, hospitals, and other health care providers of services to an enrolled group for a fixed periodic payment.

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Prenatal care Services to pregnant women designed to ensure that both the expectant mother and the newborn are in the best health. A lack of prenatal care early in the pregnancy is associated with low birth weight and infant mortality. Present on Admission (POA) A requirement the Centers for Medicare & Medicaid Services (CMS) has mandated which requires that hospitals report if an infection was present when a patient was admitted to a facility on all secondary claims to Medicare. Preventive Care Comprehensive care emphasizing priorities for prevention, early detection, and early treatment of conditions, generally including routine physical examination, immunization, and well-person care. Primary Care Basic health care; a branch of medicine that accentuates the point when a patient first seeks assistance in a health care system and the treatment of simpler, more common illnesses and injuries. Process improvement The application of the plan-do-study-act (PDSA) philosophy to processes to produce positive improvement and better meet the needs and expectations of customers. Prospective Payment System (PPS) A method of financing health care that mandates payments in advance for the provision of services and is based on diagnostic related groups. Provider A hospital, physician, group practice, nursing home, pharmacy, or any individual or group of individuals that provides a health care service. Provider Reimbursement Review Board (PRRB) A federal board responsible for making decisions regarding provider appeals on Medicare reimbursement issues. Provider-sponsored organization (PSO) A provider-owned entity that is certified by the Centers for Medicare and Medicaid Services to participate in the Medicare+Choice program and to assume risk for benefits provided to Medicare beneficiaries.

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Public option A government-run health-insurance plan that could offer coverage at a cost below that of private insurance plans because of lower administrative costs and possibly lower reimbursements to doctors and hospitals.

Q Quality assurance A formal set of activities to review and improve the quality of services provided. Quality assurance includes quality assessment and corrective actions to remedy any deficiencies identified in the quality of direct patient, administrative, and support services. Quality improvement A continuous effort to provide services at the highest level of quality at the lowest level of cost. Quality improvement organization (QIO) QIOs hold contracts with CMS to make sure patients get the right care at the right time, particularly among underserved populations. QIOs are directed to ensure that Medicare payment is made only for medically necessary services and to investigate beneficiary complaints about quality of care. The Carolinas Center for Medical Excellence (CCME) has been the designated QIO in North Carolina since 1984 (formerly Medical Review of NC). www.thecarolinascenter.org/

R Rate-setting The determination by a government body of rates a health care provider may charge private-pay patients. Recovery Audit Contractors (RAC) Recovery audit contractors review old Medicare claims to discover overpayments and underpayments. RACs are paid on the basis of a percentage of the overpayments they recover. Referring Physician A physician who sends a patient to another source for examination, surgery, or to have specific procedures performed, usually because the referring physician cannot adequately provide the needed service. Refined diagnosis related group (RDRG) An expanded list of diagnosis related groups to take into account a patient's severity of illness. Regional Advisory Committees (RACs) Each county and hospital in NC is currently included in at least one of seven Regional Advisory Committees. RACs were initially established for the purpose of regional trauma planning, to

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include establishing and maintaining a coordinated trauma system. Following Sept. 11, 2001, RAC responsibilities and members significantly expanded to account for increased disaster and terrorism related activities. The NC Office of Emergency Medical Services (NCOEMS) oversees the RACs in NC and works with them to coordinate their responsibilities regarding the state's trauma/terrorism initiatives. Registered Nurse (RN) One who has graduated from a college or university program of nursing education and has been licensed by the state. Reinsurance A type of insurance purchased by primary insurers from secondary insurers. A commercial or captive insurance company purchases reinsurance to protect against part or all losses the primary insurer might assume in honoring claims of its policyholders. Rescission Insurance companies' practice of dropping patients after they file expensive claims, on the grounds that applicants misrepresented their health history when they signed up for coverage. Resource-Based Relative Value Scale (RBRVS) Medicare fee schedule for physician services that sets a uniform payment in each geographic area for most of the approximately 7,000 medical procedures. Resource Utilization Group (RUG) A classification for nursing home patients whose resident information is similar and who have a certain per diem reimbursement rate. Return on investment (ROI) A measure of a company’s ability to use its assets to generate additional value for shareholders. It is calculated as net profit divided by net worth and is expressed as a percentage. Risk The chance or possibility of loss. Also used to refer to the insured or to the property coverage by a policy. Risk is also defined in health insurance terms as the possibility of loss associated with a given population. In an HMO setting, often employed as a utilization control mechanism. Risk classification The process by which a company decides how its premium rates should differ according to the risk characteristics of individual insureds.

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Risk management The practice of identifying and analyzing loss exposures and taking steps to minimize the financial impact of the risks they impose. Root cause The most fundamental reason for the failure or inefficiency of a process. Also called underlying cause. Root Cause Analysis (RCA) A process for identifying the basic or causal factor(s) that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. Rural Health Clinic (RHC) A health care organization that is in compliance with the federal Rural Health Clinics Act. RHCs must be located in a medically underserved area or a health professions shortage area, use physician assistants and/or nurse practitioners to deliver services, provide preventive services, and be licensed by the state. Rural Referral Center Hospitals located in rural areas that meet certain criteria to be paid the Medicare prospective payment system’s urban rate, adjusted by the rural wage index. Qualifying criteria include such things as having at least 275 beds and a minimum volume of discharges annually.

S Safety net providers Providers who have a mission or mandate to deliver large amounts of care to uninsured or other vulnerable patients (e.g., public hospitals, teaching hospitals, community health centers or clinics). Safe Practices Practices that reduce the risk of harm from the processes, practices or systems of healthcare, the standardization of which is likely to have significant benefit for patient safety if fully implemented. Satisfaction Measures Measures that address the extent to which the patients/enrollees, practitioners and/or purchasers perceive their needs to be met. Schedule H A special section of IRS Form 990 for nonprofit entities that is required to be completed by hospitals, providing details on community benefit and other activities.

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Sentinel event An unexpected occurrence involving death or serious physical or psychological injury, or the risk, thereof. Service Area The geographical area in which a managed care plan is licensed to provide health care services to its members; or the region served by a hospital or other health care provider. Severity Adjustment Classification of patients by severity-of-illness data to allow for meaningful comparison of performance and quality among organizations and practitioners. Single payer A system in which a government insures all its citizens, paid for by tax dollars. It is used by Britain and Canada. Skilled nursing facility (SNF) A facility, either freestanding or part of a hospital, that accepts patients in need of rehabilitation and medical care that is of a lesser intensity than that received in the acute care setting of a hospital. Sole Community Provider Health care facility located in an isolated area that serves as the only source of emergency, outpatient, and inpatient care in the region. These facilities receive a special designation from the Health Care Financing Administration and a different payment formula that provides for greater reimbursement. Specialty hospital A limited-service hospital designed to provide one medical specialty such as orthopedic or cardiac care. Special Operations Response Team SORT is a private non-profit organization located in Winston-Salem, is a federally supported disaster medical team that responds nationwide. Stark II The commonly used name for federal laws and regulations that ban physician referral to entities with which the physician has a financial relationship. State Children’s Health Insurance Program (SCHIP) See "Children’s Health Insurance Program (CHIP)"

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State fiscal year The state government's accounting year, which begins July 1 and ends June 30 Stop loss The point at which a third party has reinsurance to protect against the overly large single claim or the excessively high aggregate claim during a given period of time. Large employers that self-insure may purchase reinsurance for stop loss purposes. Subacute care Care given to patients who require less than a 30-day length of stay in a hospital and who have a more stable condition than those receiving acute care. Subsidies In the context of health-care reform, these are financial credits from the government that are distributed to Americans — calculated based on income — that Americans could use to purchase health insurance. Supplemental medical insurance Private health insurance, also called medigap insurance, designed to supplement Medicare benefits by covering certain health care costs that are not paid for by the Medicare program. Supplemental Security Income (SSI) A federal program of income support for low income, aged, blind and disabled persons established by Title XVI of the Social Security Act. Qualification for SSI often is used to establish Medicaid eligibility. Swing beds Acute care hospital beds that can also be used for a different level of care. System error An error that is not the result of an individual's action, but the predictable outcome of a series of actions and factors that comprise a diagnostic or treatment process.

T Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) A federal law that authorizes health plans to enter into arrangements with the Centers for Medicare & Medicaid Services for cost and risk contracts.

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Teaching hospital A hospital that has an accredited medical residency training program and is typically affiliated with a medical school. Telemedicine Health care consultation and education using telecommunication networks to transmit information. Tertiary care Highly specialized care given to patients who are in danger of disability or death. Third-party administrator A person or organization that manages the payment, processing, and settlement of life, health, dental, disability, and self-funded insurance claims for another person or organization. TITLE XVIII A section of the U.S. Social Security Act that authorizes and details the parameters of the Medicare Program. TITLE XIX A section of the U.S. Social Security Act that authorizes and details the parameters of the Medicaid Program. TITLE XXI A section of the U.S. Social Security Act that establishes the Children’s Health Insurance Program (CHIP). Tort A negligent or intentional civil wrong not arising out of a contract or statute that injures someone in some way and for which the injured person may sue the wrongdoer for damages. Total margin The ratio of total revenue to total costs or expenses, including non-patient care Transparency A movement toward providing more information to the public on hospital operation costs and quality. Trauma center Trauma center verification is the process by which the American College of Surgeons confirms that a hospital is performing as a trauma center and meets the criteria contained in the ACS

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Resources for Optimal Care of the Injured Patient document. The designation of a trauma facility and its role in a trauma system is a political process enacted by local, regional, or state government. Triage The process by which patients are sorted or classified according to the type and urgency of their conditions. TRICARE A program that pays for care delivered by civilian health providers to retired members and dependents of active and retired members of the seven uniformed services of the United States. Formerly called CHAMPUS.

U Uncompensated care All health care services for which a provider is not compensated, including bad debt, charity care, and other services that go unpaid. (See "charity care") Underlying cause The most fundamental reason for the failure or inefficiency of a process. Also called root cause. Underinsured People with some type of health insurance but not enough to cover all their health care needs. Uniform Billing Code of 2004 (UB-04) A federal directive requiring a hospital to follow specific billing procedures, itemizing all services included and billed for on each invoice. Uniform hospital discharge data set A defined set of data that gives a minimum description of a hospital discharge. It includes data on age, sex, race, residence of patient, length of stay, diagnosis, physicians, procedures, disposition of the patient and sources of payment. Uninsured People who lack health insurance of any kind. Unpreventable Adverse Event An adverse event resulting from a complication that cannot be prevented given the current state of knowledge.

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Upper Payment Limit (UPL) The maximum amount states can pay providers for Medicaid services. Urgent care Medical care for illness or injury requiring attention at a level higher than for a physician office visit but less than the level of emergency care. U.S. Department of Health and Human Services (HHS) A department within the executive branch of the federal government responsible for Social Security and federal health programs in the civilian sector. www.dhhs.gov U.S. House Energy and Commerce Committee A congressional committee whose primary jurisdiction includes most hospital- and health care-related issues. Members of this committee have significant influence over the development of federal health care policy and funding. energycommerce.house.gov U.S. House Committee on Ways and Means A congressional committee with primary oversight of Medicare, Social Security and other public welfare programs. Also responsible for legislation concerning taxes, bonded debt and tariffs. waysandmeans.house.gov U.S. Senate Committee on Finance A congressional committee dealing with Medicare, Medicaid, federal bonds, the customs service and related issues, public moneys, revenue sharing, health programs funded by specific taxes, national social security and general revenue matters. Members of this committee have significant influence over the development of federal health care policy and funding. finance.senate.gov U.S Senate, Health Education, Labor, and Pensions Committee (HELP) A congressional committee whose primary jurisdiction includes most hospital- and health care-related issues. Members of this committee have significant influence over the development of federal health care policy and funding. www.senate.gov/~labor/ Usual, customary and reasonable charges (UCR) Charges for health care services in a geographical area that are consistent with the charges of identical or similar providers in the same geographic area. Utilization The patterns of use of a service or type of service within a specified time, usually expressed in a rate per unit of population- at-risk for a given period (e.g., the number of hospital admissions per year per 1,000 persons in a geographic area).

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Utilization review (UR) An evaluation of the necessity and appropriateness of the use of health care services, procedures, and facilities.

V Value-based purchasing (VBP) A purchasing program designed to transform Medicare from a passive payer of claims to an active purchaser of care. These programs make a portion of the hospital payment contingent on actual performance of specified measures, rather than simply on the hospital’s reporting data. Ventilator Associated Pneumonia (VAP) A sub-type of hospital-acquired pneumonia (HAP) which occurs in people who are on mechanical ventilation through an endotracheal or tracheotomy tube.

W Wage index A factor used to adjust the base Medicare reimbursement rates for an area to account for geographic differences in wages paid to health care workers. Weapon of mass destruction Weapons capable of inflicting mass casualties and destruction; including nuclear, biological and chemical weapons or the means to deliver them. Well-baby care Services provided in the first year of a newborn's life to identify, treat, and prevent health care problems. Workers’ Compensation (WC) Provides state-mandated insurance coverage for work-related injuries and disabilities. World Health Organization (WHO) A specialized agency of the United Nations generally concerned with health and health care.

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Healthcare Acronyms

A AA — Anesthesiologist Assistant AACN — American Association of Colleges of Nursing AAFP — American Academy of Family Physicians AAP — American Academy of Pediatrics AAPC — Adjusted Average Per Capita Cost ABIM — American Board of Internal Medicine ACHE — American College of Healthcare Executives AAHP — American Association of Health Plans AAP — American Academy of Pediatrics AARP— American Association of Retired Persons ACG — Ambulatory Care Group ACO — Accountable Care Organization ACP — American College of Physicians ACPV — Average Cost per Visit ACS — American College of Surgeons ACU — Ambulatory Care Unit ADA — Americans with Disabilities Act of 1990 ADATC — Alcohol and Drug Abuse Treatment Center ADC— Average Daily Census ADE — Adverse Drug Event ADG — Ambulatory Diagnostic Group ADL— Activities of Daily Living ADJ —Adjusted Claim ADR — Adverse Drug Reaction ADS — Alternate Delivery System ADT — Admission/Discharge Transfer AHA — American Hospital Association AHC — Academic Health Center AHEC — Area Health Education Center AHIMA — American Health Information Management Association AHPA — American Health Planning Association AHRQ — Agency for Healthcare Research and Quality AIDS — Acquired immune deficiency syndrome ALJ — Administrative Law Judge ALOS — Average length of stay AMA — American Medical Association AMI — Acute Myocardial Infarction ANA — American Nurses Association ANDI — NCHA’s Advocacy Needs Data Initiative AoA — Administration of Aging AONE — American Organization of Nurse Executives A/P — Accounts Payable APC — Ambulatory Payment Class APD — Adjusted Patient Day APR — Adjusted Payment Rate APIC — Association for Professionals in Infection Control and Epidemiology APN — Advanced Practice Nurse A/R — Accounts Receivable ARRA— American Recovery and Reinvestment Act of 2009 ASC — Ambulatory Surgical Center

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ASHE — American Society for Healthcare Engineering ASHMM — American Society for Healthcare Materials Management ASHP — American Society of Health Systems Pharmacists ASHPR — American Society for Hospital Public Relations ASHRM — American Society for Hospital Risk Managers AWI — Area Wage Index

B BBA— Balanced Budget Act of 1997 BBRA — Balanced Budget Refinement Act of 1999 BCA — Blue Cross Association BCBSNC — Blue Cross Blue Shield of NC BHO — Behavioral Health Organization BIPA — Benefits Improvement and Protection Act of 2000 BLS —Basic Life Support BME — Board of Medical Examiners BP — Blood Pressure BSN — Bachelor of Science in Nursing

C CABHA — Critical Access Behavioral Health Agency CAE — Certified Association Executive CAH — Critical Access Hospital CAH — Critical Access Hospital CAHPS — Consumer Assessment of Healthcare Providers and Systems CAP — Capitation CAPS — Claims Automated Processing System (SSA MBR) CAT — Computerized Axial Tomography CBO — Congressional Budget Office CBO — Community-Based Organization CC — Condition Code CCNC— Community Care of North Carolina CCME — Carolina Center for Medical Excellence CCT — Comprehensive Crisis Treatment CCTP — Community-based Care Transitions Program CCU — Cardiac Care Unit CDC — Centers for Disease Control and Prevention C.diff — Clostridium Difficile CE — Continuing Education CEO — Chief Executive Officer CFO — Chief Financial Officer CME — Continuing Medical Education CAUTI — Catheter Associated Urinary Tract Infection CERT — Center for Emergency Response and Terrorism (DHSS) CERT — (Medicare) Comprehensive Error Rate Testing CHAMPUS — Civilian Health and Medical Program of the Uniformed Services (now TRICARE) CHAMPVA — Civilian Health and Medical Program of the Veterans Administration CHC — Community Health Center CHE — Certified Healthcare Executive CHIME — Center for Health Information Management and Evaluation CHIP — Children’s Health Insurance Program (NC Health Choice) CHNA — Community Health Needs Assessment CICU — Cardiac Intensive Care Unit

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CIO — Chief Information Officer CLABSI — Central-line Associated Bloodstream Infection CLASS — Community Living Assistance Services and Support CLIA — Clinical Laboratory Improvement Act CME — Continuing Medical Education CMO — Chief Medical Officer CMMI — Center for Medicare and Medicaid Innovation CMI — Case Mix Indicator CMR — Computerized Medical Record CMS — Centers for Medicare and Medicaid Services CN — Claim Number CNO — Chief Nursing Officer COA — Council on Accreditation COB — Coordination of Benefits COBRA — Consolidated Omnibus Reconciliation Act of 1985 COC — Certificate of Coverage COE — Center of Excellence COLA — Cost of Living Adjustment CON — Certificate of Need COO — Chief Operating Officer CoP — Conditions of Participation COPD — Chronic Obstructive Pulmonary Disease CPA — Certified Public Accountant CPE — Certified Public Expenditure CPHQ — Certified Professional in Healthcare Quality CPI — Consumer Price Index CPM — Clinical Performance Measure CPOE — Computerized Physician Order Entry CPR — Cardiopulmonary Resuscitation CPT — Current Procedural Terminology CQI — Continuous Quality Improvement CQM — Clinical Quality Measure CR — Change Request CRNA — Certified Registered Nurse Anesthetist CT — Computed Tomography CWF — Common Working FIle CY — Calendar Year

D DA — Disability Assistance DAW — Dispense as Written DB — Deaf Blind DD — Developmental Disability, Developmentally Delayed DDS — Disability Determination Services DDS — Doctor of Dental Surgery DEA — Drug Enforcement Administration DHHS — NC Department of Health and Human Services DHSR — NC Division of Health Service Regulation DHS — Department of Homeland Security DMA — NC Division of Medical Assistance DME — Durable Medical Equipment DMH/DD/SAs — Division of Mental Health, Developmental Disabilities & Substance Abuse Services DNR — Do-Not-Resuscitate

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DoA — Division of Aging DO — Doctor of Osteopathy DOA — Dead on Arrival DOB — Date of Birth DOC — Department of Correction DOD — Department of Defense DOE — Department of Education (federal) DOJ — Department of Justice (federal) DOL — Department of Labor DOS — Date of Service DOT — Department of Transportation DPH— Division of Public Health DPI — Department of Public Instruction DRA — Deficit Reduction Act DRG — Diagnosis Related Group DSA — Digital Subtraction Angiography DSB — Division of Services For The Blind DSDHH — Division of Services For The Deaf And Hard of Hearing DSH — Disproportionate Share Hospital DSS — Department of Social Services (county) Division of Social Services (state) DT — Day Treatment DWAC — DHHS Waiver Advisory Committee Dx — Diagnosis

E EAP — Employee Assistance Program EBP — Evidence-Based Practice ECF — Extended Care Facility ECG/EKG — Electrocardiogram ECS — Electronic Claims Submission ECU — Environmental Control Unit ED — Emergency Department EDI — Electronic Data Interchange EDP — Electronic Data Processing EDS — Electronic Data Systems EEG — Electroencephalogram EEOC — Equal Employment Opportunity Commission EHR — Electronic Health Records EKG/ECG — Electrocardiogram EMG — Electromyogram EMR — Electronic Medical Records EMS — Emergency Medical Systems EMT — Emergency Medical Technologist EMTALA — Emergency Medical Treatment and Active Labor Act ENT — Ears, Nose and Throat EOB — Explanation of Benefits EOL — End of Life EOMB — Explanation of Medicare Benefits EOP — Emergency Operations Plan EP — Emergency Preparedness EPA — Environmental Protection Agency EPSDT — Early Periodic Screening, Diagnosis and Treatment ER — Emergency Room

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ERISA — Employee Retirement Income Security Act ESRD — End Stage Renal Disease

F FACHE — Fellow of American College of Healthcare Executives FAH – Federation of American Hospitals FASB — Financial Accounting Standards Board FCC — Federal Communications Commission FCRA _ Fair Credit Reporting Act FDA — Food and Drug Administration FEC — Freestanding Emergency Center FEMA — Federal Emergency Management Agency FFP — Federal Financial Participation FFS — Fee For Service FFY — Federal Fiscal Year FI — Fiscal Intermediary FISS — Fiscal Intermediary Standard System FLEX — Medicare Rural Hospital Flexibility Program FMAP — Federal Medical Assistance Percentage rate FMEA — Failure Modes and Effects Analysis FMG — Foreign Medical Graduate FMLA — Family Medical Leave Act FNP— Family Nurse Practitioner FOIA — Freedom of Information Act FP — Family Practitioner FPL — Federal Poverty Level FQHC — Federally Qualified Health Center FRA — Federal Reimbursement Allowance FSA — Flexible Spending Account FTC — Federal Trade Commission FY — Fiscal year FYE — Fiscal Year Ending FTE — Full-Time Equivalent FY — Fiscal Year

G GAAP — Generally Accepted Accounting Principles GAO — General Accounting Office GAF — Geographic Adjustment Factor GAP — Gap Assessment Program GASB — Governmental Accounting Standards Board Financial Accounting GDP — Gross Domestic Product GI — Gastrointestinal GME — Graduate Medical Education GNP — Gross National Product GP — General Practice GPCI — Graduate Practice Cost Index GPO — Group Purchasing Organization

H HAI — Healthcare Associated Infections

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HB — House Bill (state) HCAP — Health Care Associated Pneumonia HCAP — Hospital Care Assurance Program HCBS — Home and Community-Based Services HCFA — Health Care Financing Administration (renamed CMS in 2001) HCPCS — Healthcare Common Procedure Coding System HCPP — Health Care Prepayment Plan HCQIA — Health Care Quality Improvement Act HCW — Health Care Worker HEBI — Hospital Employee Benefits, Inc HEC — Hospital Engagement Contractor HEDIS® — Health Plan Employer Data and Information Set HEICS — Hospital Emergency Incident Command System HEN — Hospital Engagement Network HFMA — Healthcare Financial Management Association HH — Home Health HHA — Home Health Agency HHS – US Department of Health and Human Services HIAA — Health Insurance Association of America HICS — Hospital Incident Command System HIDI — Hospital Industry Data Institute HIE — Health Information Exchange HIM — Health Information Management HINN — Hospital Issued Notice of Non-coverage HIPAA — Health Insurance Portability and Accountability Act HIS _ Hospital Information System HIT — Health Information Technology HITECH — Health Information Technology for Economic and Clinical Health Act HIV — Human Immunodeficiency Virus HMBI — Hospital Market Basket Index HMO — Health Maintenance Organization HMSA — Health Manpower Shortage Area HOSPAC —Hospital Political Action Committee (NCHA’s PAC) HPID — Health Plan Identifier HPOE — Hospitals in Pursuit of Excellence (AHA) HPS — Hospital Purchasing Service HPSA — Health Professional Shortage Area HQRM — Healthcare Quality and Resource Management H.R. — House Resolution (federal legislation only. See HB for state legislation.) HRA — Health Risk Assessment HRET — Hospital Research and Educational Trust (AHA) HRSA — Health Resources and Services Administration HSA — Health Savings Account HSA — Health Service Agency HSR — Hospital Specific Rate HSP — Health Service Plan HVA — Hazard Vulnerability Assessment

I IBNR — Incurred But Not Reported ICD-9-CM — International Classification of Diseases, Ninth Revision, Clinical Modification ICD-10-PCS — International Classification of Diseases, 10th Revision, Procedure Coding System ICF — Intermediate Care Facility

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ICN — Intermediate Care Nursery ICU — Intensive Care Unit IDD — Intellectual and Developmental Disabilities IDS — Integrated Delivery System IG — Inspector General IHI — Institute for Healthcare Improvement IHN — Integrated Health Network IJ — Immediate Jeopardy ILC — Independent Living Center IME — Indirect Medical Education IOM — Institute of Medicine IP — Inpatient IPA — Independent Practice Association IPAB — Independent Payment Advisory Board IPF — Inpatient Psychiatric Facility IPPS — Inpatient Prospective Payment System IPRS — Integrated Payment and Reimbursement System IRB — Institutional Review Board IRF — Inpatient Rehabilitation Facility IS — Information System ISMP — Institute for Safe Medication Practices IT — Information Technology IV — Intravenous IVC — Involuntary Commitment

J J11 — Jurisdiction 11 Part B (NC) JCAHO — The Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations) JCC — Joint Conference Committee JCR — Joint Commission Resources

K KBR — Kate B. Reynolds Charitable Trust

L LCD — Local Coverage Determinations LCP — Licensed Clinical Psychologist LCSW — Licensed Clinical Social Worker LDR — Labor and Delivery Room LME — Local Management Entity LMRP — Local Medical Review Policy LOB — Legislative Office Building LOC — Legislative Oversight Committee LOS — Length of Stay LPC — Licensed Professional Counselor LPN — Licensed Practical Nurse LTAC — Long-term Acute Care Hospital LTC — Long-term Care LTCF — Long-term Care Facility LVN — Licensed Vocational Nurse

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M MA — Medicare Advantage MAC — Medicare Administrative Contractor MAC — Maximum Allowable Costs MACPAC — Medicaid and CHIP Payment Access Commission MBI — Market Basket Index MCAC — Medical Care Advisory Committee MCC — Medical Care Commission MCO — Managed Care Organization MCT — Mobile Crisis Team MD — Medical Doctor MedPAC — Medicare Payment Advisory Commission MFS — Medicare Fee Schedule MGCRB — Medicare Geographic Classification Review Board MHA — Master of Healthcare Administration MI — Myocardial Infarction MIC — Medicaid Integrity Contractor MIG — Medicaid Integrity Group MIP — Medicaid Integrity Program MIPPA — Medicare Improvement for Patients and Provider Act MLP — Midlevel Practitioner MLR — Medical Loss Ratio MMA — Medicare Modernization Act MMI — Maximum Medical Improvement MMR — Measles, Mumps, and Rubella MOA — Memorandum of Agreement MPH — Master of Public Health MRI — Magnetic Resonance Imaging MRI — Medicaid Reimbursement Initiative MRSA — Methicillin-Resistant Staphylococcus Aureus MSA — Medical Savings Account MSA — Metropolitan Statistical Area MSN — Master of Science in Nursing MSO — Management Service Organization MSP — Medicare Secondary Payer MU — Meaningful Use MUA — Medically Underserved Area MUP — Medically Underserved Population MUR – Monthly Utilization Report MVPS —Medicare Volume Performance Standard

N N3CN — NC Community Care Networks NAPH — National Association of Public Hospitals NB — Newborn NCAFP — NC Academy of Family Physicians NCBON — North Carolina Board of Nursing NCD — National Coverage Determinations NCHA — NC Hospital Association NCHCFA — NC Health Care Facilities Association NCHESS — NC Hospital Emergency Surveillance System NCHEX — NC Healthcare Exchange NCHS — National Center for Health Statistics

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NCHV — NC Hospital Volunteers NCIOM — NC Institute of Medicine NCMS — NC Medical Society NCNA — NC Nurses Association NCONL — NC Organization of Nurse Leaders NCPHP — NC Physician Health Plan NCPP — NC Prevention Partners NC SHIM — NC System for Hospital Infection Measurement NCTN — NC Telehealth Network NCAHP — NC Association of Health Plans NCHA — NC Hospital Association NCHF — NC Hospital Foundation NCHS — National Center for Health Statistics NCQA — National Committee for Quality Assurance NCQC — The NC Center for Hospital Quality and Patient Safety (The NC Quality Center) NDC — National Drug Code NHSN — National Healthcare Safety Network NICU — Neonatal Intensive care unit NIH — National Institutes of Health NoCVA —North Carolina-Virginia Hospital Engagement Network NP — Nurse Practitioner NPI — National Provider Identifier NPRM — Notice of Proposed Rulemaking NPSF — National Patient Safety Foundation NPSP — National Patient Safety Partnership NQF — National Quality Forum NUBC — National Uniform Billing Committee

O OASIS — Outcome and Assessment Information Set OB-GYN — Obstetrics and Gynecology OBRA — Omnibus Budget Reconciliation Act OEID — Other Entity Identifier OIG — Office of Inspector General OMB — Office of Management and Budget ONC — Office of the National Coordinator OP — Outpatient OPHP — Office of Public Health Preparedness OPO — Organ Procurement Organization OPPS — Outpatient Prospective Payment System OR — Operating Room OSHA — Occupational Safety and Hazard Agency OT — Occupational Therapy OTC — Over-The-Counter

P PA — Physician Assistant PAC — Political Action Committee P&L — Profit and Loss PBH — LME formerly called Piedmont Behavioral Health PBM — Pharmacy Benefit Management Company PCCM — Primary Care Case Management

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PCMH — Patient Centered Medical Home PCN — Primary Care Network PDL — Prescription Drug List PDP — Prescription Drug Plan PDR — Physicians’ Desk Reference PDC — Policy Development Committee (NCHA) PET — Positron Emission Tomography PFP — Partnership for Patients PFS — Patient Financial Services PHI — Protected Health Information PHIX — Public Health Information Exchange PHO — Physician Hospital Organization PHR — Personal Health Record PIP — Periodic Interim Payment (Medicare) PML — Patient Monthly Liability PMPM — Per Member Per Month POA — Present On Admission POS — Point-of-Service PPACA — Patient Protection and Accountable Care Act PPI — Provider Price Index PPO — Preferred Provider Organization PPRC — Physician Payment Review Commission PPS — Prospective Payment System PRO — Peer Review Organization ProPAC — Prospective Payment Assessment Commission PRRB — Provider Reimbursement Review Board PSDA — Patient Self-Determination Act PSN — Provider Sponsored Organization PSO — Patient Safety Organization PSRO — Professional Standards Review Organization PS&R — Provider and Statistical Reimbursement System PT — Physical Therapy PTA — Physical Therapy Assistant

Q QA — Quality Assurance QAP — Quality Assurance Program QHi — Quality Health Indicators QI — Quality Improvement QIO — Quality Improvement Organization QIP — Quality Improvement Plan QM — Quality Management QMB — Qualified Medicare Beneficiary QOL — Quality of Life

R RAB — Regional Advisory Board RAC — Recovery Audit Contractor RAC — Regional Advisory Committee (Disasters/Terrorism) RAD — Radiation Absorbed Dose R&D — Research and Development RBRVS — Resource-Based Relative Value Scale

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RCA — Root Cause Analysis RDRG — Refined Diagnosis Related Group REC — Regional Extension Center RFP — Request for Proposal RHC — Rural Health Clinic RHIO — Regional Health Information Organization RN — Registered Nurse ROA — Return on Assets ROE — Return on Equity ROI — Return on Investment RPB — Regional Policy Board (AHA) RPCH — Rural Primary Care Hospital RPh — Registered Pharmacist RPT — Registered Physical Therapist RRA — Registered Record Administrator RRT — Registered Respiratory Therapist RRTs — Regional Response Teams RT — Respiratory Therapist/Therapy RUG — Resource Utilization Group RV — Residual Volume RVS — Relative Value Scale RVU — Relative Value Unit RWJ — Robert Wood Johnson Foundation Rx — Prescription RY — Rate Year

S S. — Senate resolution (federal legislation only. See SB for state legislation.) SAD — Self-Administered Drugs SB — Senate Bill (state legislation only. See S. for federal legislation.) SBH — Swing-Bed Hospital SCH — Sole Community Hospital SCHIP — State Children's Health Insurance Program (NC Health Choice) SCU — Special Care Unit SEC — Securities and Exchange Commission SGR — Sustainable Growth Rate SHCC — State Health Coordinating Council SHIM — System for Hospital Infection Measurement SHSMD — Society for Healthcare Strategy and Market Development SIC — Standard Industry Code SICU — Surgical Intensive Care Unit SIDS — Sudden Infant Death Syndrome SLMB — Specified Low Income Medicare Beneficiaries SLP — Speech Language Pathologist SMDA — Safe Medical Devices Act of 1990 SMFP — State Medical Facilities Plan SMI — Supplemental Medical Insurance SMRS — State Medical Response System SMSA — Standard Metropolitan Statistical Area SNF — Skilled Nursing Facility SORT — Special Operations Response Team SPA — State Plan Amendment for Medicaid SPECT — Single Photon Emission Computed Tomography

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SSA — Social Security Administration SSI — Supplemental Security Income SSI — Surgical Site Infection ST — Speech Therapist

T TAC — Technical Advisory Committee TANF — Temporary Assistance for Needy Families TBI — Traumatic Brain Injury TDE — The Duke Endowment TEFRA — Tax Equity and Fiscal Responsibility Act of 1982 TJC— The Joint Commission TOPS — Transitional Outpatient Payments TPA — Third-Party Administrator TPL — Third-Party Liability TQI — Total Quality Improvement TQM — Total Quality Management TRICARE — Formerly the Civilian Health and Medical Program of the Uniformed Services or CHAMPUS TTD — Temporary Total Disability

U UB-04 — Uniform Billing Code of 2004 UB-92 — Uniform Billing Code of 1992 UDI — Unique Device Identifier UHI — Universal Health Insurance UPL — Upper Payment Limit UR — Utilization Review USPCC — US Per Capita Cost

V VA — Veterans Administration VAP — Ventilator-Associated Pneumonia VBP — Value-Based Purchasing VHA — Voluntary Hospitals of America (known now as VHA) VR — Vocation Rehabilitation

W WC — Workers’ Compensation WHO — World Health Organization WI — Wage Index WIC — Women and Infant Children Program

Y YTD — Year to Date

Z ZPIC — Zone Program Integrity Contractor