Managed Care Glossary of Terms

Second Edition 1999

---

A

AAAHC	Accreditation Association for Ambulatory Healthcare
AAHP	American Association of Health Plans
AAPCC	Adjusted Average Per Capita Cost
AAPPO	American Association of Preferred Provider Organizations
ABC	Activity-based Costing
ACR	Adjusted Community Rating
ADA	Americans with Disabilities Act
ADL	Activities of Daily Living
ADS	Alternative Delivery System
AGPA	American Group Practice Association
AHA	American Hospital Association
AHCPR	Agency for Health Care Policy and Research
AHP	Accountable Health Plan
AMA	American Medical Association
AMBHA	American Managed Behavior Healthcare Association
AMC	Academic Medical Center
AMPRA	American Peer Review Association
ANA	American Nurses Association
APA	American Pharmaceutical Association
APCC	Adjusted per Capita Cost
APDRG	All Patient Diagnosis-Related Groups
APG	Ambulatory Patient Group
APR	Adjusted Payment Rate
APR-DRG	All Patient Refined Diagnosis-Related Group
ASO	Administrative Services Only
AVG	Ambulatory Visit Group

 

B

 

C

CAHPS	Consumer Assessments of Health Plans Study
CalPERS	California Public Employees Retirement System
CCN	Chronic Care Network
CHAMPUS	Civilian Health and Medical Program of the Uniformed Services
CHC	Community Health Center
CHIP	Children's Health Insurance Program
CHPA	Community Health Purchasing Alliances
CMI	Case-Mix Index
CMP	Competitive Medical Plan
COA	Certificate of Authority
COB	Coordination of Benefits
COBRA	Consolidated Omnibus Budget Reconciliation Act
COC	Certificate of Coverage
CON	Certificate of Need
COPC	Community Oriented Primary Care
CPT-4	Current Procedural Terminology, Fourth Edition
CQI	Continuous Quality Improvement
CRVS	California Relative Value Studies
CSO	Clinical Service Organization

 

D

DCA	Deferred Compensation Administrator
DCI	Duplicate Coverage Inquiry
DCO	Direct Contracting Organization
DHHS	Department of Health & Human Services
DOS	Date of Service
DPN	Designated Provider Network
DRG	Diagnosis-Related Group
DSH	Disproportionate Share
DUR	Drug Utilization Review

 

E

EAP	Employee Assistance Program
EMR	Electronic Medical Record
EOI	Evidence of Insurability
EPO	Exclusive Provider Organization
EPSDT	Early and Periodic Screening, Diagnosis, and Treatment
ERISA	Employee Retirement Income Security Act

 

F

FAcct	Foundation for Accountability
FFS	Fee-For-Service
FQHC	Federally Qualified Health Cente
FSA	Flexible Spending Account

 

G

GHAA	Group Health Association of America

 

H

HCFA	Health Care Financing Administration
HCPCS	HCFA Common Procedural Coding System
HCPP	Health Care Prepayment Plan
HCQIA	Health Care Quality Improvement Act
HCQII	Health Care Quality Improvement Initiative
HEDIS	Health Plan Employer Data and Information Set
HHS	Health and Human Services
HIAA	Health Insurance Association of America
HIPAA	Health Insurance Portability and Accountability Act
HIPC	Health Insurance Purchasing Cooperative
HMO	Health Maintenance Organization
HMSA	Health Manpower Shortage Area
HPSA	Health Professions Shortage Areas
HRSA	Health Resources and Services Administration
HSA	Health Systems Agency

 

I

IBNR	Incurred But Not Reported
ICD-9-CM	International Classification of Diseases, Ninth Revision, Clinical Modification
IDS	Integrated Delivery System
IHS	Integrated Healthcare System
IOM	Institute of Medicine
IOS	Intensity of Service
IPA	Independent Practice Association
IPN	Integrated Provider Network
IPO	Individual Practice Organization
ISN	Integrated Service Network

 

J

JCAHO

Joint Commission on Accreditation of Healthcare Organizations

 

K

 

L

LOS	Length of Stay
LTC	Long-Term Care

 

M

MCCA	Medicare Catastrophic Coverage Act of 1988
MCO	Managed Care Organization
MCR	Medical Cost Ratio
Med-PAR	Medicare Provider Analysis and Review File
MedTEP	Medical Treatment Effectiveness Program
MSO	Management Services Organization

 

N

NAHDO	National Association of Health Data Organizations
NAIC	National Association of Insurance Commissioners
NCHS	National Center for Health Statistics
NCHSR	National Center for Health Services Research
NCQA	National Committee on Quality Assurance
NIH	National Institutes of Health
NIMH	National Institute of Mental Health
NPDB	National Practitioner Data Bank

 

O

OBRA	Omnibus Budget Reconciliation Act
OHMO	Office of Health Maintenance Organizations
OPM	Office of Personnel Management
OSHA	Occupational Safety and Health Administration

 

P

PACE	Program of All Inclusive Care for the Elderly
PBM	Pharmacy Benefits Manager
PC/PM	Per Contract/Per Month
PCCM	Primary Care Case Management
PCG	Physician Care Groups
PCN	Primary Care Network
PCP	Primary Care Provider or Physician
PHO	Physician-Hospital Organization
PIP	Physician Incentive Plan
PMPM	Per Member Per Month
POS	Point-of-Service
PPMC	Physician Practice Management Company
PPO	Preferred Provider Organization
PPRC	Physician Payment Review Commission
PPS	Prospective Payment System
PRO	Peer Review Organization
PRO	Physician Review Organization
ProPAC	Prospective Payment Assessment Commission
PSN	Provider Sponsored Network
PSO	Provider Sponsored Organization
PSRO	Professional Standards Review Organization
PTMPY	Per Thousand Members Per Year

 

Q

QA	Quality Assurance
QM	Quality Management

 

R

RBRVS

Resource-Based Relative Value Scale

 

S

SCH	Sole Community Hospital
SHMO	Social HMO
SNF	Skilled Nursing Facility
SOI	Severity of Illness

 

T

TEFRA	Tax Equity and Fiscal Responsibility Act
TPA	Third Party Administrators
TQM	Total Quality Management

 

U

UB-92	Uniform Billing Code of 1992
UCDS	Uniform Clinical Data Set
UCR	Usual, Customary and Reasonable
UM	Utilization Management
UPIN	Universal Physician Identification Number
UR	Utilization Review