| Term |
Definition |
| Academic Medical Center |
A hospital that also functions as a formal center of learning for the training of physicians, nurses and other health professionals. |
| Access |
Potential and actual entry of a person/population into the healthcare delivery system. |
| Accountable Care Organization |
A group of healthcare providers who provide coordinated care, chronic disease management and thereby improve the quality of care patients receive. The organization's payment is tied to achieving healthcare quality goals and outcomes that result in cost savings. |
| Accounts Payable |
Amounts the hospital owes to vendors or others for goods and services received. |
| Accounts Receivable |
Amounts owed to the hospital by patients, or third-party payers on behalf of patients, for services provided or goods sold. |
| Accreditation |
A process whereby a professional association or non-governmental agency grants recognition to a healthcare institution, provider or program for demonstrated ability to meet predetermined criteria for established standards. The term generally refers to the evaluation by The Joint Commission (see The Joint Commission (TJC), formerly JCAH/JCAHO). |
| Accreditation Survey |
The process employed to determine whether a healthcare institution, provider or program meets specified standards for accreditation. |
| Activities of Daily Living (ADL) |
Basic self-care activities, including eating, bathing, dressing, transferring from bed to chair, bowel and bladder control and independent ambulation. ADLs are widely used as a measure of evaluating functional status. |
| Acuity |
Severity or degree of illness. |
| Acute Care |
Generally refers to inpatient hospital care of a short duration as opposed to ambulatory care or long-term care for the chronically ill. |
| Adjusted Community Rate (ACR) |
How premium rates are decided based on members’ collective use of benefits and not on an individual’s use of benefits. |
| Adjusted Patient Day (APD) |
An aggregate number representing the number of days of inpatient care plus equivalent inpatient days attributed to outpatient services. Equivalent inpatient days are calculated by multiplying inpatient days by the ratio of total charges (inpatient plus outpatient charges) to total inpatient charges. |
| Adult Medical Day Care |
A program that provides a combination of health, recreational and social services to older adults during the day or evening. Services include comprehensive assessment, health monitoring, occupational therapy, personal care, a meal and transportation. Some programs also provide primary healthcare and rehabilitation services. |
| Advance Directive |
An advance directive is a legal document that directs preferences for various medical treatment options if an individual becomes unable to make his or her own healthcare decisions. An advance directive becomes effective if a person’s physician has determined that the individual is unable to understand his or her diagnosis, treatment options or the possible benefits and harms of the treatment options. New Jersey has two kinds of advance directives, a “proxy directive” and an “instruction directive.” |
| Adverse Drug Event |
An adverse event related to improper medication at any dose. |
| Adverse Event |
An adverse event is any undesirable experience associated with the use of a medical product in a patient. |
| Affordable Care Act (ACA) |
The comprehensive healthcare reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law. |
| All Patient Diagnosis Related Groups (AP-DRGs) |
These patient classification groups expand the basic DRG structure to be more representative of non-Medicare populations, such as pediatric patients. |
| Allied Health Professionals |
Professionally educated and certified non-physician healthcare providers, including nurse practitioners, certified registered nurse anesthetists, respiratory therapists, physician assistants and others. |
| All-Payer System |
A system in which payment rates are set by the government. |
| Alternative Delivery |
An alternative to traditional inpatient care (e.g., ambulatory care, same-day surgery, home healthcare, etc.). |
| Alternative Payment Model (APM) |
Term used to describe post-fee-for-service payment models. For Quality Payment Program (QPP) Medicare physician reimbursement, APMs are limited to models where clinicians eclipse Medicare reimbursement and patient thresholds to become eligible for incentive payments. As outlined by the Medicare Access and CHIP Reauthorization Act (MACRA), participants in an advanced APM are eligible for a 5 percent incentive payment. |
| Alternative Therapies |
Treatments for behavioral health consumers other than the traditional hospitalization and institutional care options. These programs include various community-based treatment programs and facilities. |
| Ambulatory Care |
Care delivered on an outpatient basis, including primary care, same-day surgery and outpatient diagnostic services. |
| Ancillary Services |
Services—other than room and board, medical and nursing services—provided to hospital patients in their course of care, including laboratory, radiology, pharmacy and rehabilitation therapy services. |
| Area Wage Index (AWI) |
An adjustment in the Medicare hospital inpatient prospective payment system (PPS) reflecting market condition in the hospital’s location. The AWI is intended to measure differences in hospital wage rates among labor markets; it compares the average hourly wage for hospital workers in each metropolitan statistical area (MSA) or statewide rural area to the nationwide average. |
| Assertive Case Management |
An intensive form of case management intended to help individuals increase daily-task functioning, residential stability, independence and to reduce their hospitalizations. Assertive case management substantially reduces inpatient service use, promotes continuity of outpatient care and increases community tenure and residence stability for people with severe mental illness. |
| Assertive Community Treatment (ACT) |
This treatment, sometimes referred to as Program of Assertive Community Treatment (PACT), is a team-based approach to the provision of treatment, rehabilitation and support services. |
| Assignment |
An agreement by a physician to be paid directly by Medicare or a third-party payer and accept the payment amount Medicare or the third-party payer approves for the service as payment in full (less any applicable deductible and/or coinsurance amounts, which remain the patient’s responsibility). |
| Assignment of Benefits |
An agreement by a patient that an out-of-network provider can pursue reimbursement directly on behalf of the patient. |
| Assisted Living |
A coordinated array of supportive personal and health services available to residents who have a need for these services. They can be provided in a licensed assisted living facility, a comprehensive personal care home or in subsidized senior housing (through an assisted living program provider). Assisted living promotes self-direction, independence, individuality, privacy, dignity and homelike surroundings. |
| Assisted Outpatient Treatment (AOT) |
Known as outpatient commitment (OPC), the legal process whereby a judge can order an individual with serious mental illness to adhere to a court-ordered mental health treatment plan. The purpose of AOT is to assist adults with serious mental illness who are thought to be unsafe living in their community without supervision and treatment and who are unwilling to voluntarily participate in treatment. |
| Association Health Plan |
Health insurance plans that are offered to members of an association. The plans are marketed to individual association members, as well as small business members. |
| Auxilian |
Member of a hospital auxiliary who may or may not be an in-service volunteer within the affiliated hospital. |
| Balance Sheet |
A component of an organization’s audited financial statements, divided into three sections: assets, liabilities and net worth or owners’ equity. The balance sheet shows the financial position of an organization at a particular point in time. |
| Behavioral Health |
A state of mental health, emotional wellbeing and/or choices and actions that affect wellness. Substance use disorder, acute psychological distress, suicide and mental illness are often categorized as behavioral health diagnoses. |
| Benchmarking |
The process of continually measuring products, services and practices against major competitors or industry leaders. |
| Biomedical Ethics |
A term used to describe philosophical questions involving morals, values and ethics in the provision of healthcare. |
| Board Certified |
A physician or other health professional who has passed an examination given by a specialty board and has been certified by that board as a specialist in that subject. |
| Bundled Payment |
The practice of paying an all-inclusive package price for all healthcare services associated with certain surgical procedures or medical conditions. |
| Cadillac Tax |
An excise tax on high-cost health plans offered by employers. Though originally scheduled to be imposed in 2018, the tax will not be imposed until 2020 when health plans that cost more than $10,200 for an individual or $27,500 for a family plan will be subject to the tax, which is 40 percent of the amount that exceeds those thresholds. For example, if a family plan costs $30,000, the employer that offers the plan would owe 40 percent of $2,500 ($30,000 minus $27,500), or $1,000 for each family it covers under that plan. |
| Capital Asset |
Depreciable property of a fixed or permanent nature, such as property, plant or equipment that is not held for sale in the regular course of business. |
| Capital Cost |
A hospital’s costs for major fixed or durable assets, such as plant and property, movable equipment, and working capital. (see Depreciation) |
| Capital Formation |
Methods for obtaining and accumulating funds for capital needs such as major equipment or buildings. |
| Capitation |
A method of paying for health services on a per-person basis as opposed to fee-for-services basis. For example, HMOs charge subscribers a fixed fee per person or family for comprehensive coverage. (see Alternative Delivery, HMO, IPA, PPO) |
| Caps |
Maximum allowable limits placed on revenue or rates by the federal or state government. |
| Captive Insurance Companies |
A wholly owned subsidiary of a group of hospitals that have organized to insure their risk. A captive is similar to a self-insurance company program that has assumed the formalities of an insurance company. |
| Cardiac Catheterization |
A minimally invasive procedure used to diagnose disorders of the heart, lungs and great vessels. |
| Carve-Out |
Services not included in a health plan, but available from another supplier or agent at a different, usually higher, fee. |
| Case Management |
A system of assessment, treatment planning, referral and follow-up that ensures the provision of services according to client needs and the coordination of payment and reimbursement for care. A case manager acts as a client advocate, monitoring the individual’s progress through the system. |
| Case Mix |
A measure of patient acuity reflecting different patients’ needs for hospital resources. There are many ways of measuring case mix; some are based on patients’ diagnoses or the severity of their illnesses, and some on their utilization of services. A high case mix index refers to a patient population that is more ill than average. |
| Catastrophic Illness |
Any acute or prolonged illness that is usually considered to be life-threatening or with the threat of serious residual disability and that entails large expense over an extended period. |
| Catchment Area |
Geographic area defined and served by a hospital and delineated on the basis of such factors as population distribution, natural geographic boundaries or transportation accessibility. |
| Center for Behavioral Health Statistics and Quality (CBHSQ) |
Within the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Administration, CBHSQ is responsible for the data collection, analysis and dissemination of behavioral health data. |
| Center for Medicare and Medicaid Innovation (Innovation Center) |
The Innovation Center identifies, creates, tests and evaluates new payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care furnished to Medicare, Medicaid and Children’s Health Insurance Program beneficiaries. |
| Center for Mental Health Services (CMHS) |
Part of the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services. CMHS works with state and local behavioral health authorities, service providers, consumers and their families to improve and increase the quality and range of mental health-related prevention, treatment, recovery and support services. |
| Centers for Medicare and Medicaid Services (CMS) |
Formerly known as HCFA (Health Care Financing Administration), CMS is the governmental department that administers Medicare and the State Children’s Health Insurance Program (SCHIP) and co-administers, with individual states, the Medicaid program. |
| Certificate of Need (CN) |
A certificate issued by the N.J. Department of Health to a hospital or other healthcare facility seeking permission to modify its facility, acquire major medical equipment or offer a new or different health service. |
| Certification |
A workforce assessment process that fosters the growth of a qualified, ethical and culturally diverse workforce through test-based certification and/or a licensing program and the enforcement of a code of ethics. |
| Certified Application Counselor (CAC) |
An individual (affiliated with a designated organization) who is trained and able to help consumers, small businesses and their employees look for health insurance options primarily through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers. NJHA utilizes a team of United States veterans as CACs. |
| Charge |
The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different than the amount paid. |
| Charge Master |
The list of the lines of services provided in a facility, with each line containing charge number and other data components. The charge number is used to generate a bill for the services, supplies and pharmaceuticals provided to the patient during an episode of care. |
| Charity Care |
Free or reduced-charge care provided to qualified, low-income individuals who receive inpatient and outpatient services at acute care hospitals throughout the state of New Jersey. Under New Jersey’s charity care law, all acute care hospitals are required to care for all patients in all settings, regardless of their ability to pay. |
| Children’s Health Insurance Plan (CHIP) or State Children’s Health Insurance Plan (SCHIP) |
A state administered program funded equally by state and federal dollars that allows states to provide health coverage to uninsured low-income children not previously eligible for Medicaid. In New Jersey, the program was designed as NJ KidCare—but has now been broadened and renamed NJ FamilyCare. |
| Claim |
A formal request by a healthcare provider to receive payment for services. |
| Claims-Made Coverage |
A liability policy form that covers claims made against the insured during the policy period irrespective of when the event occurred that caused the claim to be made. |
| Claims-Made Policy |
Coverage extends to claims-made (reported or filed) during the year the policy is in force or during a previous period in which the policyholder was insured under a claims-made contract, provided the coverage is continuous with the insurer. |
| Clinical Department |
In a departmentalized hospital, the department in which the medical staff organization is subdivided into major divisions such as medicine, surgery, obstetrics-gynecology, pediatrics and family medicine. Each clinical department has a chief or chairman and is responsible for setting and monitoring standards of professional and personal conduct of physicians within those departments. |
| Clinical Integration |
A care delivery design approach that can improve efficiency, reduce costs and improve patient outcomes through more consistent use of clinical standards by physicians and organizations. “Vertical” clinical integration involves aligning care delivery between hospitals and physicians or hospitals and continuing care providers. “Horizontal” clinical integration involves aligning across non-corporate-related providers. |
| Clinical Pathway |
see Critical Pathway |
| Clinical Privileges |
The right to provide medical or surgical care services in the hospital, within well-defined limits, according to an individual's professional license, education, training, experience and current clinical competence. Hospital privileges must be delineated individually for each practitioner by the hospital board, based on medical staff recommendations. |
| Closed Staff |
As applied to the medical staff as a whole, an arrangement in which no new applicants are accepted. |
| COBRA |
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances. |
| Code of Federal Regulations |
A codified collection of regulations issued by various departments, bureaus and agencies of the federal government that is published in the Federal Register. |
| Co-Insurance |
Requirement of an insurance policy that the beneficiary pay a predetermined percentage of the provider’s charges for services provided. |
| Commercial Carriers |
For-profit, private insurance carriers (e.g., Aetna, Prudential) offering health and other types of coverage. |
| Community Benefits |
Activities initiated by nonprofit hospitals to benefit the hospital’s community that are not reimbursable by a health plan. Community benefits are evolving standards defined by the Internal Revenue Service (IRS) to maintain the tax-exempt status of nonprofit healthcare organizations. |
| Community Health Center |
A local, community-based ambulatory healthcare program organized and funded by the U.S. Public Health Service that provides primary and preventive health services, often called neighborhood health centers. They are usually located in an area with scarce health services or with a population with special health needs. There are also similar non-federally funded community health programs, sponsored by local hospitals and/or community foundations. |
| Community Health Needs Assessment (CHNA) |
A process undertaken by a hospital organization at least once every three years and as required by the Internal Revenue Service Code Section 501(r) to maintain its tax-exempt status. The assessment must be written and describe, among other specified requirements, the health status and quality of life among residents of the communities served as well as significant health needs that the hospital intends to address. |
| Community Healthcare Assets Protection Act (CHAPA) |
A state law that provides for Attorney General review prior to applying to the Superior Court of New Jersey to approve the acquisition of a hospital. The Attorney General must make a determination that acquisition is in the public interest, the criteria for which includes: whether the non-profit hospital exercised due diligence; the procedures followed in making the decision; whether conflicts of interest were disclosed; whether the acquisition proceeds will be used for appropriate charitable healthcare purposes or for the support and promotion of healthcare; and whether the proceeds are controlled independently of the purchaser or parties to the acquisition. |
| Community Mental Health System |
A system intended to provide public mental health services directly to those in need of assistance in the communities where they reside. It is intended to provide a community-based alternative to institutional care for individuals with mental illness. |
| Community Rating |
A method used to determine a health insurance premium in which a premium is based on the average cost of the actual or anticipated health services used by all subscribers in a specific geographic area, age, gender or industry. This method spreads the cost of illness evenly over all subscribers rather than charging the sick more than the healthy. Pure community rating is based on paying status, geography and benefits only. Modified community rating is based on demographics and lifestyle (e.g., age banded, gender, tobacco use). |
| Community-based Services |
A concept of treatment that focuses on the services offered to an individual through a system of community support. Individuals with mental illness can remain in their community if given support and access to mainstream resources such as housing and vocational opportunities. |
| Comorbidity |
A secondary illness or condition. |
| Comprehensive Accreditation Manual for Hospitals (CAMH) |
An annual publication by The Joint Commission consisting of policies and procedures relating to hospital accreditation surveys, hospital standards and scoring guidelines used to determine levels of compliance with the standards. (see The Joint Commission (TJC), formerly JCAH/JCAHO) |
| Comprehensive Healthcare |
Services that meet the total healthcare needs of a patient. |
| Comprehensive Joint Replacement (CJR) Bundle |
A mandatory five-year Medicare program of the federal government that took effect in April 2016 with the goal of coordinating and integrating physician, hospital and post-hospital care through a revised payment structure. Forty New Jersey hospitals are required to be in CJR and Medicare beneficiaries who undergo a hip or knee replacement surgery must participate. |
| Computerized Axial Tomography (CT or CAT) |
An advanced, noninvasive method of radiological diagnosis that creates “images” of the body in a computerized display. |
| Conditions of Participation (COP) |
Conditions that healthcare organizations must meet to participate in the Medicare and Medicaid programs. |
| Congregate Housing |
Housing for older adults that includes access to a variety of support services such as laundry or linen service, meal service, a security system, socialization opportunities or transportation. Individual apartments usually include kitchen facilities. |
| Consortium |
Formal voluntary alliance of institutions, usually from the same geographic area, for a specific purpose that functions under a set of bylaws. |
| Consumer |
An individual that uses healthcare services, i.e., a patient; an active participant in the purchase of healthcare services; a term frequently applied to a person receiving mental health or substance use disorder services. |
| Consumer Directed Health Plan |
(see High Deductible Health Plan) |
| Consumer-operated Programs |
Peer-to-peer services that are administratively controlled and operated by consumers and that emphasize self-help as their operational approach. |
| Continuing Care Retirement Community (CCRC) |
A full-service community offering a long-term contract that provides for a continuum of care, including independent living, assisted living and skilled nursing services, usually all on one campus. |
| Continuous Quality Improvement |
An approach to organizational management that focuses on meeting consumer needs and expectations and using scientific methods to improve work processes and the empowerment of all employees to engage in continuous improvement of their work processes. |
| Continuum of Care |
A comprehensive system of long-term care services and supports in the community, as well as in institutions. The continuum includes: - Community services such as senior centers;
- In-home care such as home-delivered meals, homemaker services, home health services, shopping assistance, personal care, chore services and friendly visiting;
- Community-based services such as adult day care;
- Non-institutional housing arrangements such as congregate housing, shared housing, assisted living, residential healthcare facilities and board and care homes;
- Nursing homes and sub-acute care facilities;
- Rehabilitation hospitals/units;
- Programs of All-Inclusive Care for the Elderly (PACE);
- Long-term care hospitals (LTCHs); and
- Acute care services.
|
| Contractual Allowances |
Negotiated discounts from hospital-established charges agreed to between specific payers and providers. |
| Conversion |
A major change that a hospital undertakes, such as the conversion from nonprofit status to for-profit or the conversion of an acute care facility to ambulatory care. This usually entails a complete change of mission after a new line of business or service displaces a core activity. |
| Co-occurring Disorder |
Two or more disorders occurring simultaneously. Generally refers to mental health and substance use disorders but can refer to mental health, physical health, developmental or other disorders; also referred to as dual diagnosis or comorbid conditions. |
| Co-Payment |
A fixed amount a beneficiary pays for a covered healthcare service, usually at the time service is rendered. The amount can vary by the type of covered healthcare service. |
| Corporate Restructuring |
The formation and use of one or more corporations in addition to the hospital corporation for the purpose of holding assets or carrying out other business activities. Restructuring generally involves either the formation of corporations legally independent of the hospital or the hospital becoming a subsidiary of a new parent corporate structure. |
| Cost |
The definition of cost varies by the party incurring the expense: - To the patient, cost is the amount payable out of pocket for healthcare services.
- To the provider, cost is the expense (direct and indirect) incurred to deliver healthcare services to patients.
- To the insurer, cost is the amount payable to the provider or reimbursable to the patient for services rendered.
- To the employer, cost is the expense related to providing health benefits (premiums or claims paid).
|
| Cost Accounting |
A process which determines the full and incremental costs of providing healthcare services to patients. Hospital cost accounting systems are software systems that integrate financial and resource utilization data that typically already exists in other hospital information databases, including hospital billing, payroll, general ledger and individual departments’ resource utilization databases. |
| Cost Finding |
Determining how much it actually costs to provide a given service. Usually requires a cost accounting system or a retrospective cost study. |
| Cost Sharing |
Having consumers pay a portion of the cost of their healthcare bills or insurance premiums. Usually includes co-insurance and co-pays of the beneficiary. |
| Cost Shifting |
Increasing the charges to one group of hospital patients or payors to cover or subsidize losses on other groups of patients or payors. |
| Cost-to-Charge Ratio (CCR) |
The relationship between a hospital’s cost of providing services and the charge assessed by the hospital for the service. The CCR may be calculated at the organization level or at the department level. Historical CCRs are typically used to estimate costs by multiplying the ratio against current charges. |
| Covered Service |
A healthcare service that qualifies for full or partial reimbursement by Medicare or an insurance company. |
| Credentialing |
The process of checking a practitioner’s references and documenting his/her credentials, including training and education, experience, demonstrated ability, licensure verification and malpractice insurance. The hospital governing board has ultimate accountability for physician credentialing but usually delegates the process to the medical staff committee. |
| Creditable Coverage |
Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS and TRICARE; the Federal Employees Health Benefits Program; Indian Health Service; the Peace Corps; Public Health Plan (any plan established or maintained by a state, the U.S. government, a foreign country); Children’s Health Insurance Program (CHIP); or a state health insurance high risk pool. The Affordable Care Act (ACA) requires individuals to maintain creditable coverage as a condition of the individual mandate. |
| Critical Pathway |
Treatment regimen agreed on by a consensus of clinicians. It includes only those few vital elements proven to affect patient outcomes. Only critical components—items that directly affect care—are part of the critical pathway. |
| Cultural and Linguistic Competence |
The ability of healthcare providers and healthcare organizations to understand and respond effectively to the cultural and linguistic needs brought by the patient to the health care encounter. |
| Dashboard |
A variety of indicators displayed visually, similar to a car’s dashboard. This is key information easy to read to indicate areas of success and those that need improvement. Dashboards often cover clinical quality, revenue, full time employees, patient satisfaction, etc. |
| Deductible |
A dollar amount that the consumer must pay before the insurance company will assume any liability for all or part of the remaining cost of covered services. |
| Deemed Status |
A hospital is “deemed qualified” to participate in the Medicare program if it is accredited by The Joint Commission, thus eliminating the need for a duplicative Medicare accreditation survey. |
| Dementia |
A usually progressive condition marked by deteriorated cognitive function often with emotional apathy. |
| Denial |
The refusal by a third-party payer to reimburse a provider for services or a refusal to authorize payment for services prospectively. Denials are generally issued on the basis that a hospital admission, diagnostic test, treatment or continued stay is or would be inappropriate according to a set of guidelines. |
| Dependent |
A child or other individual for whom a parent, relative or other person may claim a personal exemption tax deduction. |
| Dependent Coverage |
Insurance coverage for family members of the policyholder, such as spouses, children or partners. |
| Depreciation |
The amortization of the cost of a physical asset (plant, property and equipment) over its useful life. Annual depreciation is the amount charged each year as expense for such assets as building, equipment and vehicles. Accumulated depreciation is the total amount of depreciation on the hospital’s financial books. Funded depreciation refers to setting aside and investing the accumulated depreciation so that these monies can be used for replacement and renovation of assets. |
| Developmental Disability |
A substantial impairment in mental or physical functioning with onset before the age of 22 and of indefinite duration. |
| Diagnosis-related Groups (DRGs) |
A system for classifying hospital patients based on their clinical condition (diagnosis or surgical procedure), age and whether they had any other illnesses (complications or comorbidities); a predetermined price is set for each of more than 500 DRGs. DRGs are used by the federal government for Medicare’s prospective pricing system. |
| Diagnostic and Statistical Manual of Mental Disorders (DSM) |
The standard reference handbook used by mental health and substance use disorder professionals to classify conditions. |
| Direct Contracting |
A direct contractual arrangement between an employer and a provider or provider organization for the provision of healthcare services. The two parties may negotiate rates for services in a variety of ways, such as discounted charges, per diem rates or DRGs. Direct contracts may include use of third-party administrators for claims processing, utilization management or other administrative functions. Direct contracting is often used as a cost-containment strategy since fewer costs are incurred by a “middleman” insurance company. |
| Direct Cost |
Costs that are wholly attributable to the service in question, such as the services of professional and paraprofessional personnel, equipment and materials. |
| Directors and Officers Liability Insurance |
Protection for directors and officers of corporations against suits or claims brought by stockholders or others alleging that the directors and/or officers acted improperly in some manner in the conduct of their duties. This coverage does not extend to dishonest acts. |
| Discharge Planning |
A planning process that assists patients and their families in arranging services they will need after discharge from a hospital or other healthcare facility or program. |
| Disproportionate Share Hospital (DSH) |
In the Medicare program, disproportionate share hospitals are those that treat a large number of low-income patients and receive additional operating and capital payments to offset the financial effects of these patients. More generally, the term refers to any hospital that provides care to a large number of patients who cannot afford to pay or do not have insurance. |
| Diversion |
In mental health and substance use disorder programs, diversion addresses the specific needs of a person who has been “diverted” from the criminal justice system either before arrest or before trial. |
| Do-Not-Resuscitate Order (DNR) |
An order placed on a patient’s chart by the attending physician, with a patient or surrogate that directs hospital personnel not to revive the patient if respiratory or cardiac activity ceases. |
| Drug Formulary |
A listing of prescription medications approved for use by and in a hospital; also used to identify those prescription medications approved for use and/or coverage by health insurance plans. |
| Dual Eligible |
A person who is entitled to Medicare and Medicaid benefits. |
| Durable Medical Equipment Services (DME) |
The sale or rental of products and/or equipment designed to assist individuals needing medical care at home. It can include, but is not limited to, wheelchairs, canes, walkers and respirators. |
