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In addition to the glossary of terms below, the Communications Committee is pleased to provide the following one-page guides to terminology specific to the different departments our members support.

Clinical Terminology

Human Resources Terminology

Legal Terminology
 
 
Abuse Abuse is the improper usage or treatment of an entity, often to unfairly or improperly gain benefit.
Affordable Care Act (ACA) Also known as the Patient Protection and Affordable Care Act, this federal legislation was passed in March of 2010 and contains new health reform provisions.
AHRQ (Agency for Healthcare Research and Quality) A federal agency within the Public Health Service responsible for research on quality, appropriateness, and cost of health care. AHRQ also centralizes access to state inpatient data.
Anti-Kickback Statute A federal law passed in 1972 that provides for criminal and civil penalties on individuals or entities that offer payment or solicit or receive remunerations in exchange for Medicare, Medicaid or other federally financed health care program referrals.
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare and Medicaid Services
Comorbidity A preexisting patient condition that, linked to a principal diagnosis, causes an increase in length of stay by at least one day in approximately 75 percent of cases.
CoP (Conditions of Participation) The federal regulations hospitals must comply with in order to qualify for Medicare reimbursement.
Corporate Responsibility A form of corporate self-regulation integrated into a business model.
DOJ Department of Justice
DRG (Diagnostic Related Group) A system of classifying patients on the basis of diagnoses for the purpose of payment to hospitals; for payment under Medicare’s PPS and by some other payers. The ERG system classifies patients into groups based on the principal diagnosis, type of surgical procedure, presence or absence of significant comorbidities or complications and other relevant criteria. DRGs are intended to categorize patients into groups that are clinically meaningful and homogeneous with respect to resource use.
DRP Disaster Recovery Plan
EMTALA (Emergency Medical Treatment and Active Labor Act) EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay. If they are transferred to another facility, they must be stabilized first.
EQRO (External quality review organization) States are required to contract with an entity that is external to and independent of the state and its health maintenance organization (HMO) and health insurance organization (HIO) contractors to perform an annual review of the quality of services furnished by each HMO or HIO contractor.
False Claims Act A federal law sometimes used to charge hospitals with fraud and abuse.
Fraud In criminal law, fraud is intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent, and verb is defraud. Fraud is a crime and a civil tort at common law, though the specific criminal law definition varies by legal jurisdiction.Defrauding people or entities of money or valuables is a common purpose of fraud.
OCR Office of Civil Rights
OIG Office of Inspector General
ONCHIT Office of the National Coordinator for Healthcare Information Technology
OSHA Occupational Safety and Health Administration
Qui Tam (Whistleblower) Action A lawsuit brought by a private citizen (popularly called a "whistle blower") against a person or company who is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation, when there is a statute which provides for a penalty for such violations.
Safe Harbor Laws A set of federal regulations providing safe refuge for certain health care business arrangements (primarily physician-hospital arrangements) from the criminal and civil sanction provision of the Medicare Anti-Kickback Statute prohibiting illegal remunerations.
Sarbanes Oxley (SOX) Federal legislation passed by the U.S. Congress to protect shareholders and the general public from accounting errors and fraudulent practices in the enterprise, as well as improve the accuracy of corporate disclosures.
Stark Law Prohibits a physician or immediate family member who has a financial relationship with an entity from referring a Medicare or Medicaid patient to the entity for health services.
Telemedicine/Telehealth The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.  (American Telemedicine Association)
Value-Based Purchasing (VBP) Hospital Value-Based Purchasing (VBP) is part of CMS’ effort to link a value-based system to Medicare’s payment system in an effort to improve healthcare quality.  Participating hospitals are paid for acute care inpatient services based not only on quantity of services, but quality of care provided.  The program uses the hospital quality reporting structure developed for the Hospital Inpatient Quality Reporting (IQR) Program authorized by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.