KHA

Health Care Terms and Abbreviations

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

AA: anesthesiologist assistant
AAHC/URAC: American Accreditation Healthcare Commission, formerly Utilization Review Accreditation Commission
AAMC: Association of American Medical Colleges
AAHP: American Association of Health Plans
AAPCC: Average adjusted per capita cost
AARC: American Association of Respiratory Care
AARP: American Association of Retired Persons
Abd.: Abdominal
ACC: American College of Cardiology
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.
Accreditation: Approval by an authorizing agency for institutions and programs that meet or exceed a set of pre-determined standards.
ACHE: American College of Healthcare Executives
ACM: Alternative and Complementary Medicine
ACS: American Cancer Society
ACR: Adjusted community rating
ACU: Ambulatory care unit
Acuity: Degree or severity of illness
acute care: Hospital care given to patients who generally require a stay of several days and that focuses on a physical or mental condition requiring immediate intervention and constant medical attention, equipment and personnel.
acute care bed need methodology: A formula used to determine hospital bed needs.
ADA: Americans with Disabilities Act
ADA²: American Diabetes Association
Adjusted average per capita cost (AAPCC): This is the federal calculation that determines how much Medicare pays managed care companies each month to cover Medicare beneficiaries living in a certain area.
ADL: activities of daily living
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.
Admitting privileges: The authorization given by a health care organization's governing body to medical practitioners who request the privilege of admitting and/or treating patients. Privileges are based on a provider's license, training, experience and education.
ADN: Associate Degree in Nursing
ADS: Alternative Delivery Systems
advance directive: A document that patients complete to direct their medical care when they are unable to communicate their own wishes due to a medical condition. In Ohio, do not resuscitate orders, living wills and durable powers of attorney are advance directives that are authorized by state law.
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.
adverse selection: Among applicants for a given group or individual health insurance program, the tendency for those with an impaired health status, or who are prone to higher-than-average utilization of benefits, to be enrolled in disproportionate numbers in lower deductible plans.
AF: Atrial fibrillation
AFDC: Aid to Families with Dependent Children
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.
AG: Attorney General
AGPA: American Group Practice Association
AHA: American Hospital Association or American Heart Association
AHCA: American Health Care Association
AHCPR: Agency for Health Care Policy and Research
AHRQ: Agency for Health Care Research and Quality
AI: Aortic insufficiency
AIDS: acquired immunodeficiency syndrome
ALJ: Administrative law judge
allied health personnel: Specially trained and often licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists and nurses. The term is sometimes used synonymously with paramedical personnel, all health workers who perform tasks that must otherwise be performed by a physician, or health workers who do not usually engage in independent practice.
allopathic: One of two schools of medicine that treats disease by inducing effects opposite to those produced by the disease. The other school of medicine is osteopathic.
allowable costs: Charges for services rendered or supplies furnished by a health provider which qualify as covered expenses for insurance purposes.
ALOS: Average length of stay
AMA: American Medical Association
AMA²: Against medical advice
ambulance restocking: The practice of a hospital replenishing certain drugs and supplies used by an ambulance service during transport of a patient to the hospital.
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.
ambulatory surgical facility: see freestanding outpatient surgical center
AMCRA: American Medical Care and Review Association
ANA: American Nurses Association
ancillary: A term used to describe additional services performed related to care, such as lab work, X-ray and anesthesia.
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 (i.e., the power to increase prices).
any willing provider: A term used to describe legislation that requires a health plan to accept on its provider panels every physician, hospital or other practitioner that wants to participate in the health plan's products.
AOA: American Osteopathic Association
AONE: American Organization of Nurse Executives
APC: Ambulatory Payment Classification
APG: Ambulatory Patient Groups
APN: Advanced Practice Nurse
approved health care facility or program: A facility or program that is licensed, certified or otherwise authorized pursuant to the laws of the state to provide health care and which is approved by a health plan to provide the care described in a contract.
ARNP: Advanced Registered Nurse Practitioner
ART: Accredited Record Technician
AS: Aortic stenosis
ASAE: American Society of Association Executives
ASC: Ambulatory surgery center
ASO: Administrative services only contract
Assignment: An agreement by a physician that he will bill Medicare directly and will accept the government payment as the total payment. He cannot bill the patient for the balance.
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 daily census (ADC): The average number of inpatients per day. Calculated by dividing the total number of days patients stayed in the hospital during a certain period by the total number of calendar days in that same period.
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.
AVG: Ambulatory visit group

BBA: Balanced Budget Act of 1997
BBRA: Balanced Budget Relief Act of 1999
BCAA: Blue Cross Association of America
BC/BS: Blue Cross and Blue Shield Association
BE: Barium enema
Behavioral Health Care: Mental health services, including services for alcohol and substance abuse.
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.
BIA: Bureau of Indian Affairs
BIPA: Benefits Improvement and Protection Act of 2000
BMR: Basal metabolism rate
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.
boutique hospital: A limited service hospital designed to provide one medical specialty such as orthopedic or cardiac care.
BP: Blood pressure
Brain Death: Total irreversible cessation of cerebral function, as well as spontaneous function of the respiratory and the circulatory system.
BSN: Bachelor of Science in Nursing
BUN: Blood urea nitrogen
BWC: Bureau of Workers' Compensation

Ca: Carcinoma
CADAC: Certified Alcohol and Drug Abuse Counselor
CAH: Critical Access Hospital
CAM: Complementary and Alternative Medicine
CAO: chief administrative officer
CAP: capitation
Capitation (CAP): Method of payment for health services in which a physician or hospital is paid a fixed, per capita amount for each patient served regardless of the actual number of services provided to each person.
Cardiac Catheterization: A procedure used to diagnose disorders of the heart, lungs, and great vessels.
Care Learning: An online education service of 35 state hospital associations along with the American Hospital Association (AHA) for the purpose of delivering more cost-effective education to hospitals. Click here for more information.
CARE System: The Core Analysis Research Evolution (CARE) System is a set of process measures (AMI, HF, CAP, PR) used for quality improvement. The system meets Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measurement requirements.
carrier: The Medicare Part B claims processing contractor.
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.
CAT: Computerized axial tomography
CBC: Complete blood count
CC: Chief complaint
CCI: Correct Coding Initiative (CMS)
CCU: Cardiac care unit
CDC: Centers for Disease Control
CE: Continuing Education
Centers for Medicare and Medicaid Services (CMS): (formerly the Health Care Financing Administration, or HCFA), administers the Medicaid, Medicare and State Children's Health Insurance Program.
CEO: chief executive officer
certificate of need (CON): A designation that hospitals had to obtain from the Ohio Department of Health (ODH) to authorize an activity such as constructing or modifying hospitals, purchasing certain medical equipment or providing new health care services. This process was gradually phased out for most acute care hospital activities from 1995 through 1998 and replaced with quality standards.
CFO: chief financial officer
CFR: Code of Federal Regulations
CHA: Center for Health Affairs
CHAMPUS: Civilian Health and Medical Program of the Uniformed Services
CHAMPVA: Civilian Health and Medical Program of the Veterans Administration
Chemotherapy: In the treatment of disease, the application of chemical agents which are not harmful to the patient but which have a specific and toxic effect upon the disease-causing microorganism.
CHIN: Community Health Information Network
CHIP: Children's Health Insurance Program
CICU: Cardiac intensive care unit
CIPI: Capital input price index
CISN: Community integrated service network. A smaller ISN with an enrollment limit of 50,000, plus several other restrictions.
CLIA: Clinical Laboratory Improvement Amendment also Clinical Laboratory Improvement Act
CME: Continuing Medical Education
CMHC: Community Mental Health Center
CMI: Case mix index
CMP: Competitive medical plan
CMS: Centers for Medicare and Medicaid Services (formerly HCFA)
CNM: certified nurse-midwife
CNP: certified nurse practitioner
CNS: Central nervous system
CNS²: clinical nurse specialist
COB: Coordination of benefits
COBRA: Consolidated Omnibus Budget Reconciliation Act
Code Blue: Indicates an emergency situation has occurred and mobilizes staff to respond.
COI: Certificate of Insurance
Comorbidity: A preexisting condition that, linked to a principal diagnosis, causes an increase in the length of stay by at least one day in approximately 75 percent of cases.
Computerized Axial Tomography (CAT): Scanner Diagnostic equipment which produces cross sectional images of the head and/or body.
CON: Certificate of Need
COO: chief operating officer
CORF: Comprehensive outpatient rehabilitative facility
CPI: Consumer price index
CPHA: Commission on Professional and Hospital Activities
CPR: Cardiopulmonary resuscitation
CPR²: Customary, prevailing, and reasonable (charges)
CPT: Current procedural terminology
CQI: Continuous quality improvement
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 pathway: Standardized specifications for care developed by a formal process that incorporates the best scientific evidence of effectiveness with expert opinion.
CRNA: certified registered nurse anesthetist
CSR: Continuous Survey Readiness
CVA: Cerebrovascular accident, a stroke
CVI: Cerebrovascular insufficiency

DA: Disability Assistance
D&C: Dilatation and curettage
D&E: Dilatation and evacuation
DC: Doctor of Chiropractic
DD: Differential diagnosis
DDS: Doctor of Dental Surgery
DHS: Department of Human Services
DHHS: Department of Health and Human Services (Federal)
diagnostic related group (DRG): A hospital classification system that groups patients by common characteristics requiring treatment.
DIFF.: Differential blood count
disproportionate share hospital (DSH): A hospital that provides care to a high number of patients who cannot afford to pay and/or do not have insurance.
diversion: The routing of patients to other hospitals because an emergency room is at maximum capacity.
DME: Durable medical equipment
DNR: Department of Natural Resources
DNR²: do not resuscitate
DO: Doctor of Osteopathy
DOJ: Department of Justice
DPM: Doctor of Podiatric Medicine
DPT: Diphtheria, pertussis, tetanus
DRG: Diagnosis related group used to determine Medicare reimbursement for inpatient services.
DSA: Disproportionate share adjustment
DSC: Doctor of Surgical Chiropody
DSH: Disproportionate share hospital
DVM: Doctor of Veterinary Medicine

EACH: essential access community hospital
EC: Electronic Commerce, the use of technology to enhance business operations and practices. These exchanges occur inter-company and intra-company, and are based on a variety of data exchange and communication standards and technologies. Examples of electronic commerce include electronic data interchange, fax and electronic mail (e-mail).
ECF: Extended care facility
ECU: Environmental control unit
ED: emergency department
EDI: Electronic Data Interchange, the computer-to-computer electronic transfer of business transaction information in a public standard format between trading partners.
EEG: Electroencephalogram
EENT: Eye, ear, nose and throat
EKG, ECG: electrocardiogram
EMG: Electromyogram
EMS: Emergency medical services
EMT: emergency medical technician
EMTALA: Emergency Medical Treatment and Active Labor Act
ENT: Ear, nose and throat
EOB: Explanation of benefits
EPA: Environmental Protection Agency
EPO: Exclusive provider organization
EPSDT: Early periodic screening diagnosis and treatment program
ER: Emergency room
ERISA: Employee Retirement Income Security Act
exclusions: Clauses in an insurance contract that deny coverage for select individuals, groups, locations, properties or risks.
experience rating: A system where an insurance company evaluates the risk of an individual or group by looking at the applicant's health history.

FACHE: Fellow of American College of Healthcare Executives
FAH: Federation of American Hospitals
failure mode effect analysis: 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.
FBS: Fasting blood sugar
FDA: U.S. Food and Drug Administration
FDO: formula-driven overpayment
Federal Register: An official publication of the federal government that provides final and proposed regulations of federal legislation.
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.
FEC: Freestanding emergency center
FEHBP: Federal Employees Health Benefits Plan
FFP: federal financial participation
FFS: Fee for service
FFY: federal fiscal year
FHA: Farmers Home Administration
FI: Fiscal intermediary
fiscal intermediary (FI): The Medicare Part A claims processing contractor.
fiscal note: An analysis by the Legislative Budget Office of the financial impact of proposed state legislation.
FMAP: federal medical assistance percentage
FMG: Foreign medical graduate
FOIA: Freedom of Information Act
FPL: Federal poverty level
FQHC: Federally qualified health center
Freestanding Emergency Care Center (FEC) A type of freestanding ambulatory care center that is designed, organized, equipped, and staffed to provide medical care for injuries and illnesses, including those that are life threatening.
FSH: Follicle stimulating hormone
FTC: Federal Trade Commission
FTE: Full-time equivalent
full-time equivalent (FTE): A standardized accounting of the numbers of full-time and part-time employees.
FY: fiscal year

GA: General Assistance
GAF: Geographic adjustment factor
gatekeeper: A primary care physician responsible for overseeing and coordinating all aspects of a patient's medical care and pre-authorizing specialty care.
GB viz.: Gall bladder visualization
GC: Gonococcal, gonorrhea
GCRB: Geographic Classification Review Board
GHAA: Group Health Association of America
GI: Gastrointestinal
GME: Graduate medical education
GP: General Practitioner
GPCI: Graduate practice cost index
group model HMO: An HMO that contracts with a multi-specialty medical group to provide care for HMO members. Members are required to receive medical care from a physician within the group unless a referral is made outside the network.
GU: Genitourinary

HB: House Bill
HCAP: Hospital Care Assurance Program
HCCIS: Health Care Cost Information System.
HCFA: Health Care Financing Administration (Now CMS)
HCML: Healthservices Council of Metropolitan Louisville
HCW: Health care worker
Health care cooperative: An arrangement that allows individual providers to act collectively for the purposes of providing health care services without having to merge assets.
Health Care Financing Administration: (see Centers for Medicare and Medicaid Services)
Health Insurance Portability and Accountability Act (HIPAA): The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is an industry-wide effort to improve the portability and continuity of health insurance coverage; enhance the quality and efficiency of health insurance between health care organizations; protect the security, privacy and availability of individual health information, and combat waste, fraud and abuse in health insurance and health care delivery.
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.
HEDIS: Health Plan Employer Data and Information Set
HEIP: Health Education Industry Partnership, a group created to form positive solutions to maintaining and developing a quality health care work force.
HFMA: Healthcare Financial Management Association
Hgb.: Hemoglobin
HHA: Home health agency
HHS: Health and Human Services (Federal)
HHSC: Health and Human Services Commission
HIAA: Health Insurance Association of America
HIC: health insuring corporation
HIM: Health information management
HIPCs: Health insurance purchasing cooperatives
HIPAA: Health Insurance Portability and Privacy Act of 1996
HIV: Human Immunodeficiency Virus
HMBI: Hospital market basket index
HMO: Health maintenance organization
home health agency: An organization that provides medical, therapeutic or other health services in patients' homes.
hospice: A facility or program that is licensed, certified or otherwise authorized by law, which provides supportive care of the terminally ill.
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.
HPB: Historic payment basis
HPP: Health Partnership Program
HPSA: Health Professional Shortage Area
HQRM: Healthcare quality and resource management
HR: House Resolution
HRSA: Health Resource and Services Administration
HSA: health service agency
HSR: Hospital specific rate
HVSO: Hospital Volunteer Services Organization

ICD-9-CM: International Classification of Diseases, 9th revision
ICF: Intermediate care facility
ICN: Intermediate care nursery
ICF-MR: Intermediate care facility for the mentally retarded
ICU: Intensive care unit
IDS: Integrated delivery system
IHI: Institute for Healthcare Improvement
IM: Intramuscular
IME: Indirect medical education
Integrated delivery system (IDS): Health care facilities and professionals organized and coordinated to provide comprehensive health services to a defined population group.
integrated service network (ISN): An organization that combines the insurance and health delivery aspects of health care in a single entity.
intermediate care facility (ICF): 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.
IO: intermediary organization
IOM: Institute of Medicine
IP: Intraperitoneal
IPA: Independent practice association
ISMP: Institute for Safe Medication Practices
ISN: Integrated service network
IV: Intravenous
IVP: Intravenous pyelogram (urogram)

JCAHO: Joint Commission on Accreditation of Healthcare Organizations
JCARR: Joint Committee on Agency Rule Review
JCR: Joint Commission Resources
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO): Founded in 1951, the 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.

KAHSA: Kentucky Association of Homes and Services for the Aging
KCHIP: Kentucky Children's Health Insurance Program
KHIMA: Kentucky Health Information Management Association
KONL: Kentucky Organization of Nurse Leaders
KSHE: Kentucky Society of Healthcare Engineers
KSHPRM: Kentucky Society for Healthcare Public Relations and Marketing
KSHRM: Kentucky Society for Healthcare Risk Management

LISW: Licensed Independent Social Worker
LMRP: local medical review policy
long-term acute care hospital (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. LTACHs provide care for such conditions as respiratory failure, non-healing wounds, and other diseases that are medically complex.
long-term care (LTC): Care given to patients with chronic illnesses who usually require a length of stay longer than 30 days.
LOS: Length of stay
LPC: Licensed Professional Counselor
LPN: Licensed practical nurse
LPT: Licensed Physical Therapist
LRC: Legislative Research Council
LSW: Licensed Social Worker
LTACH: long-term acute care hospital
LTC: Long-term care
LTCF: Long-term care facility
LTH: Long-term hospital
LVN: Licensed Vocational Nurse

Magnetic Resonance Imaging (MRI): A non-invasive diagnostic technique used to create images of body tissue and to monitor body chemistry; uses radio and magnetic waves instead of radiation.
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.
market basket: see hospital market basket
Market Basket Index: see Hospital Market Basket Index
MCO: Managed care organization
MD: Medical Doctor
MDA: Muscular Dystrophy Association
MDC: Major diagnostic category
MDH: Medicare-dependent hospital
Medicaid or Medical Assistance: The state and federal program providing health care to low-income and disabled people Minnesota's program is called Medical Assistance.
Medical Consumer Price Index: An inflationary statistic that measures the cost of all purchased health care services.
Medicare: The federal program providing health care coverage for those over age 65. Part A covers hospital costs. Part B covers physician and other costs. People receive Part A coverage automatically when they turn 65. Part B coverage requires them to pay a monthly premium.
Medical Payment Assessment Commission (MedPAC): A group of independent experts appointed by the federal government to give advice on issues related to Medicare payments to providers.
MedPAC: Medicare Payment Advisory Commission
mEq.: Milliequivalent
MEI: Medical economic index
MERC: Medical Education Trust Fund
MFS: Medicare fee schedule
MGCRB: Medicare Geographic Classification Review Board
MHA: Master of Hospital (Health) Administration
MHSA: Master of Health Services Administration
MI: Myocardial infarction
MI²: Mitral insufficiency
MI³: Mental institution
MMIS II Medicaid Management Information System: The Department of Human Service's Medicaid claims processing computer put on line in 1994.
MOB: Medical office building
MOM: Milk of magnesia
Mono: Mononucleosis
Morbidity: Incidence and severity of illness and accidents in a well-defined class or classes of persons.
Mortality: Incidence of death in a well-defined class or classes of persons.
MPA: Master of Public Administration
MPH: Master of Public Health
MRI: Magnetic resonance imaging
MS: Master of Science
MS²: Master Scientist
MS³: Mitral stenosis
MS⁴: Multiple Sclerosis
MSA: Metropolitan statistical area
MSN: Master of Science in Nursing
MSO: Management service organization
MSW: Master of Social Work
MUA: Medically underserved area
MUP: Medically underserved population
MVPS: Medicare volume performance standard

N: Normal
NAEHCA: National Association of Employers on Health Care Action
NAIC: National Association of Insurance Commissioners
NB: Newborn
NBME: National Board of Medical Examiners
NBRC: National Board for Respiratory Care
NCCMERP: National Coordinating Council for Medication Error Reporting and Prevention
NCHS: National Center for Health Statistics
NCHSR: National Center for Health Services Research
NCQA: National Committee for Quality Assurance
ND: Doctor of Naturopathic Medicine
Neonatal: The part of an infant's life from the hour of birth through the first 27 days, 23 hours, and 59 minutes; the infant is referred to as newborn throughout this period.
NF: Nursing facility
NIC: Neonatal intensive care
NICU: Neonatal intensive care unit
NIH: National Institute for Health
NIOSH: National Institute for Occupational Safety and Health
Nosocomial infection: An infection acquired by a patient while hospitalized.
NP: nurse practitioner
NPSF: National Patient Safety Foundation
NPSP: National Patient Safety Partnership

OASIS: Outcome and Assessment Information Set
OB-GYN: obstetrics and gynecology
OBRA: Omnibus Budget Reconciliation Act
OD: Doctor of Optometry
O.D.: Right eye
ODS: organized delivery system
OIG: Office of Inspector General
OMB: Office of Management and Budget
Omnibus Budget Reconciliation Act of 1987 (OBRA): Provided comprehensive reforms and made fundamental changes in the way nursing facilities participating in Medicare and Medicaid deliver services, staff their facilities, are inspected by government agencies, and are sanctioned when their services do not meet standards set forth in the Act.
OPO: organ procurement organization
OPPS: Outpatient Prospective Payment System.
OR: Operating room
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 JCAHO for the performance measurement system.
O.S.: Left eye
OSHA: Occupational Safety and Health Administration
osteopathic: A school of medicine that uses manipulative measures in treating patients in addition to the diagnostic and therapeutic measures of medicine. The other school is allopathic.
OT: Occupational therapy
OTC: Over-the-counter
out-of-area benefits: The coverage allowed to HMO members for emergency and other situations outside of the prescribed geographic area of the HMO.
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.
Outpatient prospective payment system (OPPS): A method of financing health care that mandates payments in advance for the provision of outpatient services and is based on ambulatory payment classification.

PA: physician assistant
PA²: Posterior-anterior
PAC: Political Action Committee
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.
P&A: Percussion and auscultation
PAT: Paroxysmal atrial tachycardia
PAT²: pre-admission testing
PBI: Protein-bound iodine
PCN: Primary care network
Ped.: Pediatrics, pediatrician
peer review: The evaluation of quality of total health care provided by medical staff with equivalent training.
peer review organization (PRO): An entity established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) to review quality of care and appropriateness of admissions, readmissions and discharges for Medicare and Medicaid. These organizations are held responsible for maintaining and lowering admission rates, and reducing lengths of stay while insuring against inadequate treatment.
Perinatal: The care of a woman before conception, of the woman and her fetus through pregnancy, and of the mother and her neonate until 28 days after childbirth.
PET: Positron emission tomography
pH: Expression of acidity or alkalinity.pH 7 is neutral; above 7 alkalinity increases; below 7 acidity decreases.
PHN: Public health nurse
PHO: Physician hospital organization
PHS: Public Health Services
Physician Assistant (PA): A specially trained and licensed health professional who performs certain medical procedures under the supervision of a physician.
PMAP: Prepaid Medical Assistance Program, this is managed care for MA enrollees.
PMPM: per member per month
Portability: The ability to move from job to job without losing health care benefits because of one's health status or a pre-existing health condition.
POS: Point of service
Position Emission Tomography (PET): An imaging technique which tracks metabolism and responses to therapy used in cardiology, neurology, and oncology; particularly effective in evaluating brain and nervous system disorders.
PPAC: Practicing Physicians Advisory Council
PPO: Preferred provider organization
PPS: Prospective payment system
Pre-Admission Certification or Assessment: Process in which a health care professional evaluates an attending physician's request for a patient's admission to a hospital by using established medical criteria.
Preemie: Premature infant
Primary Care: A point of entry into the health care system, a source of the majority of services needed by an individual on a continuing basis, and a control and referral point to other levels of care.
Primary Care Center: A type of freestanding ambulatory care center that provides primary care on a scheduled basis and is open approximately eight hours per day.
PRN: Physicians for Responsible Negotiation
PRO: Peer review organization
ProPAC: Prospective Payment Assessment Commission
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.
PRRB: Provider Reimbursement Review Board
PSA: Prostate specific antigen
PSO: Provider sponsored organization
PT: Physical therapy

QA: Quality assurance
QI: Quality improvement
QM: quality management

RAD: Radiation absorbed dose
Radiotherapy: The treatment of disease by means of x-rays or by radioactive agents.
RBC: Red blood count
RBRVS: Resource-based relative value scale
RCA: root cause analysis
RDRG: refined diagnosis related group
RFA: Regulatory Flexibility Act
RHC: rural health clinic
RN: registered nurse
RPCH: rural primary care hospital
RPB 6: Regional Policy Board 6 (AHA)

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).
SB: Senate Bill
SC: Subcutaneous
SCH: Sole community hospital
Secondary Care: Attention given to a person in need of specialty services following his referral from a source of primary care.
sentinel event: An unexpected occurrence involving death or serious physical or psychological injury, or the risk, thereof.
SFY: state fiscal year
SICU: Surgical intensive care unit
SIDS: Sudden infant death syndrome
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.
SNF: Skilled nursing facility
SOB: Short of breath
SPECT: Single photon emission computerized tomography
SSA: Social Security Act
SSI: Supplemental security income
Stat.: Immediately
State Children's Health Insurance Program (SCHIP): A program created by Congress in 1997 to help states cover more low-income children.
STD: Sexually transmitted disease
swing beds: Acute care hospital beds that can also be used for a different level of care.

T&A: Tonsillectomy and adenoidectomy
TANF: Temporary Assistance for Needy Families
TB: Tuberculosis
teaching hospital: A hospital that has an accredited medical residency training program and is typically affiliated with a medical school.
TEFRA: Tax Equity and Fiscal Responsibility Act of 1982
telemedicine: Health care consultation and education using telecommunication networks to transmit information.
Temp.: Temperature
tertiary care: Highly specialized care given to patients who are in danger of disability or death.
third-party administrator (TPA): A person or organization which manages the payment, processing and settlement of life, health, dental, disability and self-insured insurance claims for another person or organization.
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.
TPA: Third-party administrator
TQI: Total quality improvement
TQM: Total quality management
Triage: The sorting and allocation of treatment to patients, especially disaster victims, according to a system of priorities designated to maximize the number of survivors.

UAN: United American Nurses
UB-92: A revised version of the UB-82, a federal directive requiring a hospital to follow specific billing procedures, itemizing all services included and billed for on each invoice, implemented Oct. 1, 1993.
UC: Urgi center
UCR: Usual, customary and reasonable (charges)
Ultrasound: Refers to sound that has different velocities in tissues that differ in density and elasticity from others; this property permits the use of ultrasound in outlining the shape of various tissues and organs in the body.
UNOS: United Network for Organ Sharing
UR: Utilization review
utilization review (UR): An evaluation of the necessity and appropriateness of the use of health care services, procedures and facilities.

VA: Veterans Administration
VD: Venereal disease
VDRL: Serology
Veterans' Administration (VA): A federal agency responsible for veterans including VA hospitals and veterans' benefits.
VHA: Voluntary Hospitals of America

WBC: White blood count
WHO: World Health Organization
WIC: Women and Infant Children Program