| Term |
Definition |
| Magnetic Resonance Imaging (MRI) |
A high-technology diagnostic procedure that uses a magnetic scanner to create cross-sectional images of the body through the use of magnetic fields and radio frequency fields. Previously known as Nuclear Magnetic Resonance (NMR). |
| Malpractice |
Failure in providing healthcare services to exercise the degree of skill and care generally exercised by like professionals under similar circumstances. |
| Managed Care Organization (MCO) |
A health insurance provider or plan that attempts to control costs and manage care by closely monitoring patient treatment, limiting referrals to outside providers and requiring pre-authorization for hospital care and surgical procedures, physician services and post-hospital care such as nursing home or home health care. |
| Market Basket Index (Hospital) |
An index of the annual change in the prices of goods and services that providers use for producing health services. It is used by CMS to update payments and cost limits in the various CMS payment systems. The market basket is described as a fixed-weight index because it answers the question of how much more or less it would cost, at a later time, to purchase the same mix of goods and services that was purchased in a base period. As such, it measures “pure” price changes only. |
| Master Patient Index (MPI) |
An index of patients used by individual providers and organizations that treat patients. It contains the patient identifiers and the patient's identifying personal and demographic information. The MPI maintained by organizations are unique only within the organization. It serves as a directory of patients for ready reference, verification and identification of the patient and patient information. |
| Medicaid – NJ FamilyCare |
A joint federal-state program which, since 1966, has paid much of the healthcare costs of certain (but not all) low-income persons. The federal government sets certain minimum rules and payment levels and provides some of the funding. Each state administers the program, contributes additional funds and may establish additional eligibility rules and benefits. |
| Medicaid and CHIP Payment and Access Commission (MACPAC) |
A commission established by the Children’s Health Insurance Program Reauthorization Act of 2009 to review Medicaid and CHIP access and payment policies and to advise Congress on issues affecting Medicaid and CHIP. |
| Medical Director |
Physician who serves as a salaried chief of staff, generally reporting to the CEO and responsible for medical-administrative affairs. |
| Medical Education, Director of |
Member of the medical staff of a hospital or an educator who coordinates programs of graduate and continuing medical education. |
| Medical Savings Account (MSA) |
An insurance concept designed to give individuals greater control in the use of their healthcare dollars. MSAs combine a high-deductible major medical insurance policy (which usually costs less in premium payments than a low-deductible policy) with an employer-funded healthcare savings account. Employers can draw from the account to cover their first dollar healthcare expenses, typically the deductible or co-insurance. |
| Medical Staff Organization |
A body which, according to the medical staff standard of The Joint Commission (TJC), “includes fully licensed physicians, and may include other licensed individuals permitted by law and by the hospital to provide inpatient care services independently in the hospital.” These individuals together make up the “organized medical staff.” |
| Medically Indigent |
A person who, by current income standards, is not poor but lacks the financial resources to afford necessary medical services. |
| Medically Underserved Area |
Geographic location that has insufficient health resources to meet the medical needs of the resident population. |
| Medicare |
The federal health insurance program for people age 65 and over and those with certain chronic disabilities. Medicare has four parts. Part A (hospital insurance) pays for most inpatient hospital care and some follow up care. Part B (medical insurance) pays for most physicians’ services. Part C (Medicare Advantage Plans) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide individuals with Part A and Part B benefits. Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans. |
| Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 |
Federal legislation signed into law in 2015 that repealed the Medicare sustainable growth rate formula for physician payment and provided for CHIP funding through September 2017. |
| Medicare Administrative Contractor (MAC) |
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| Medicare Advantage |
A managed care program in which Medicare beneficiaries have the option to receive their Medicare benefits through private health plans, mainly health maintenance organizations (HMOs), as an alternative to the federally administered traditional Medicare program. |
| Medicare Geographic Classification Review Board |
A board that decides on requests of prospective payment system (PPS) hospitals for reclassification to another area for the purposes of receiving a higher wage index. |
| Medicare Payment Advisory Commission (MedPAC) |
An independent congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program. In addition to advising Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care and other issues affecting Medicare. |
| Medicare Supplemental Insurance |
Private insurance policies that pay some or all of Medicare’s deductibles and copayments. |
| Mental Health Parity and Addiction Equity Act |
The federal law that requires health insurance plans to cover both mental and physical health equally. Also referenced as the Paul Wellstone and Pete Domenici Mental Health Party and Addiction Equity Act of 2008 (MHPAEA). |
| Merit-based Incentive Payment System (MIPS) |
Performance-based Medicare physician payment system slated to begin Jan. 1, 2019. Physicians will be graded on performance in four categories: resource use, clinical improvement activities, quality and advancing care information. Physician payments will be adjusted beginning in 2020 based on 2018 performance. |
| Midwife, Certified Nurse |
A registered professional nurse with post-graduate education in pre-natal care and the delivery of babies. In New Jersey, certified nurse midwives must have a master’s degree in nursing and be certified by the N.J. Board of Medical Examiners. |
| Minimum Data Set (MDS) |
A standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive assessment for all residents in a Medicare and/or Medicaid-certified long-term care facility. The MDS contains items that measure physical, psychological and psychosocial functioning. |
| Mobile Crisis Teams |
On-scene response teams deployed in mental health emergencies. |
| Morbidity |
Extent of illness, injury or disability in a defined population. |
| Multi-Disciplinary Team |
An approach to caring for individuals with chronic illnesses that involves a multidisciplinary team of professionals having the goal of providing comprehensive, integrated care. The team often includes a physician, advanced practice nurse or nurse and social worker working closely together and, depending on the patient’s needs, may also include others such as an occupational, physical or other therapist, pharmacist, psychiatrist or psychologist. |
| Multi-Hospital System |
An organizational affiliation among two or more healthcare organizations. Multi-hospital systems may be vertically or horizontally integrated. The link among the institutions can be through ownership, lease, contract management or vertical integration. |
| Neonatal |
An infant’s life from the hour of birth through the first 27 days, 23 hours and 59 minutes. |
| NJ FamilyCare |
New Jersey’s publicly-funded health insurance program which includes CHIP, Medicaid and Medicaid expansion populations. |
| Nuclear Medicine |
The use of radioisotopes to diagnose and treat patients. Applications can provide images (pictures) for diagnostics and others provide diagnostic tests and treatments for disease. |
| Nurse Practitioner (NP) or Advanced Practice Nurse (APN) |
A registered professional nurse with graduate level education in a nursing specialty (i.e., family health, pediatrics, gerontology). In New Jersey, NPs and APNs are licensed by the State Board of Nursing and are qualified to carry out expanded healthcare evaluations and treatment plans. |
| Nursing Home |
A licensed and Medicare/Medicaid certified institution that provides personal, rehabilitative and nursing care for individuals, such as the elderly or chronically ill, who cannot be cared for in the community. |
| Observation |
Observation services are hospital outpatient services conducted to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged. Observation services may be conducted in the emergency department or another area of the hospital. |
| Occupancy |
Average daily census to the average number of beds maintained during the reporting period. |
| Occurrence Coverage |
A type of commercial malpractice insurance. It provides coverage for liability arising from malpractice that occurred while the policy was in effect, regardless of when the claim or potential loss is reported. |
| Occurrence Policy |
Insurance coverage provided for all events that occur while the policy is in force, regardless of when the claim is filed/reported/made. |
| Open Enrollment Period |
The time during which an uninsured individual may join a healthcare plan or insured individuals can switch plans without proving they are healthy. |
| Operating Budget |
An itemized summary of the revenues and expenses generated by a program, department or institution over a specified period of time (usually a fiscal year) related to the generation of goods or services/operations. |
| ORYX® |
ORYX is an initiative of The Joint Commission (TJC) introduced in 1997. It seeks to integrate outcome and other measurement data into the accreditation process. |
| Outcome and Assessment Information Set (OASIS) |
A CMS data set used in monitoring outcomes of adult home health patients. Providers who use and pass OASIS measurements are Medicare-certified home health agencies. |
| Outlier |
Something that falls well outside an expected range, such as Medicare inpatient beneficiaries who require longer or more intensive services—and thus incur more costs—than what is provided for in the inpatient prospective payment amount. |
| Outpatient |
A patient who receives care at a medical or psychiatric treatment facility but who is not admitted to the facility. The term may also refer to the healthcare services that such a patient receives. |
| Palliative Care |
Care primarily directed at providing symptomatic relief and support for individuals with chronic life-limiting illnesses in the last year or so of life. Palliative care can also be integrated into the management of individuals with chronic conditions such as heart failure, dialysis for improved symptom management and psychological support for the individual and family members. |
| Paramedic |
A technician with 18 months training in emergency medicine. Paramedics administer emergency care outside of the hospital. Paramedics must be licensed by the state. |
| Partnership for Patients |
Partnership for Patients is a national initiative developed by the Centers for Medicare and Medicaid Services (CMS) to improve the quality, safety and affordability of healthcare. The Partnership for Patients partners with three operational partners which include federal agencies, hospital engagement networks and private-public partners to make hospital care safer, more reliable and less costly. HENs implement the Partnership for Patients quality initiative. (see Hospital Engagement Network) |
| Patient Dumping |
The refusal to examine, treat and stabilize any person who has an emergency medical condition, or is in active labor or contractions, once that person has presented at a hospital emergency room or emergency department. (see EMTALA) |
| Patient Safety Organization (PSO) |
An entity or component organization that conducts activities to improve patient safety and healthcare quality. A patient safety organization is an entity or a component of another organization (component organization) that is listed by Agency for Health Research and Quality (AHRQ) based upon a self-attestation by the entity or component organization that it meets certain criteria established in the Patient Safety Rule promulgated by the federal Department of Health and Human Services. |
| Patient Satisfaction Survey |
A questionnaire use to solicit the perceptions of patients regarding their stay and/or service in a healthcare facility, e.g., waiting time, access to treatment, food, staff, etc. |
| Payer |
See Third-Party Payer. |
| Performance Improvement |
The continuous study and adaptation of functions and processes to increase the probability of achieving desired outcomes and better meet the needs of patients and other users of services. |
| Personal Health Record (PHR) |
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual. |
| PGY I, II, III, IV, V |
Post Graduate Year I, II, III, IV and V; a term used to identify a medical school graduate's year of post-graduate clinical training (previously known as interns and residents). |
| Physician Assistant (PA) |
Person who provides healthcare services (customarily performed by a physician) under responsible supervision of a qualified licensed physician. Physician assistants must complete an accredited education program and be licensed by a recognized agency or commission. In New Jersey, PAs are licensed by the N.J. Board of Medical Examiners. |
| Physician Quality Reporting Program |
A reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). |
| Physician-Hospital Organization (PHO) |
A legal entity formed by a hospital and a group of physicians, usually for the purpose of obtaining managed care contracts directly with employers. The PHO serves as a collective negotiating and contracting unit. |
| Point-Of-Service (POS) |
A type of managed care plan in which beneficiaries have the option of choosing to obtain medical services from the provider of their choice or a primary physician from the plan’s panel of physicians. There is a financial incentive to select a primary physician from the plan’s panel. |
| Population Profile |
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| Positron Emission Tomography (PET) |
An imaging technique that tracks metabolism and responses to therapy used in oncology, neurology and cardiology. This system is especially effective in evaluating brain and nervous system disorders. |
| Post-acute Care |
A level of care designed to improve the transition from the hospital to the community which usually includes rehabilitation and skilled nursing services that can be provided in a variety of settings, including home. |
| Post-Retirement Health Benefits (PRHBs) |
A major component of general retirement benefits that cover healthcare costs not paid by Medicare (in part or fully). They are provided to retirees through the employer’s group health plan and the set of benefits varies according to eligibility, services covered and payment. |
| Practitioner Orders for Life-Sustaining Treatment (POLST) |
A healthcare planning tool that empowers individuals to work closely with their medical team to detail their personal goals and medical preferences when facing a serious illness. The POLST form is designed to be completed jointly by an individual and a physician or advance practice nurse, expressing the individual’s goals of care and medical preferences. Unlike other documents such as an Advance Directive, a completed POLST form is an actual medical order that becomes a part of the individual’s medical record. It is also valid in all healthcare settings and the individual retains ownership of the original document. |
| Preferred Provider Organization (PPO) |
PPOs are organizational entities that have a contractual arrangement between healthcare providers (including institutions and professionals) and employers, insurance carriers or third-party payers to provide healthcare services to a defined population. There is a financial incentive for the beneficiaries to select providers from within the PPO network. Unlike HMOs, PPOs often permit patients to seek services from non-participating providers at a greater cost-sharing obligation. |
| Premium |
The amount paid to a healthcare plan by an individual (or the individual’s representative) for providing insurance coverage under a contract. This amount is distinct from an individual’s cost-sharing responsibility. |
| Price |
The total amount a provider expects to be paid by payers and patients for healthcare services. |
| Primary Care Physician |
In managed care, the physician responsible for coordinating and managing the healthcare needs of members, including hospitalization and specialist referrals. |
| Product Line |
Groupings of related business activities. A hospital’s product line might be as broad as cardiac care or surgical care, or as specific as care by DRG or product code. |
| Productivity |
The relationship between service input and output. Typical productivity measures for labor cost include full-time equivalent positions (FTE) per patient day, FTEs per admission and FTEs per bed. |
| Professional Liability Insurance |
Protection for real or alleged errors committed in the practice of a profession (e.g., Hospital Professional Liability). |
| Program of All-Inclusive Care for the Elderly (PACE) |
An at-risk, fully integrated, Medicare/Medicaid, comprehensive community-based service model for individuals who are clinically eligible for nursing home-level care, but who can remain safely at home. |
| Prospective Payment (or Pricing) System (PPS) |
A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals and skilled nursing facilities. (see Inpatient Prospective Payment System) |
| Provider |
A hospital or healthcare professional who provides healthcare services to patients; may be an entity (hospital, nursing home or other) or a person, such as a physician or nurse. |
| Provider-Sponsored Health Plan |
A health plan offered by a group of providers that assumes all financial risk. |
| Provider-Sponsored Organization (PSO) |
Healthcare systems owned and operated by providers that integrate a wide spectrum of services and contract with various entities on a managed care basis. Also known as a Provider Sponsored Network (PSN). |
| Psychosocial Rehabilitation |
Professional behavioral health services that bring together approaches from the rehabilitation and behavioral health fields. Services combine pharmacological treatment, skills training and psychological and social support to clients and families in order to improve their lives and functional capacities. |
