Category: A

A component of the payment formula under the prospective payment system (PPS) to allow for differences in wage scales in different parts of the country.  

A term used in connection with review of care to indicate whether the measures taken were proper under the circumstances, and whether it would have been proper to have taken other measures under the circumstances.  

A law in some states which requires a managed care organization, such as an HMO, to grant participation to any provider who is legally qualified as a practitioner and who is willing to become a member of the organization. Such laws are enacted to protect the patient’s freedom of choice. However they often interfere seriously…

That branch of law which seeks to prevent monopolies and unfair competition. A “trust” was originally a combination of several corporations (each maintaining its separate identity) to eliminate competition, control prices, and the like. The term “antitrust” now broadly covers any activity (or conspiracy) to eliminate competition and control the marketplace. It includes actions which…

Sometimes used to refer to the Medicare fraud and abuse laws, which prohibit, among other things, paying or receiving “kickbacks” for referral of Medicare patients. In 1972, federal legislation made it a felony for a person to receive or offer any bribe or kickback in exchange for a referral from another person in Medicare, Medicaid,…

A law which prohibits the transfer or discharge of patients for financial rather than medical reasons.  

Personnel other than physicians and nurses.  

Although this term is often used, there really is no such thing as the “American Hospital System,” except that the nation’s hospitals and other health care facilities, along with health professionals and allied health professionals, do make up an informal network across the country through which care is provided. The “American Hospital System” simply means…

A way of classifying hospital outpatient procedures for reimbursement purposes that is similar to the DRG system for inpatient services. Ambulatory patients are grouped according to clinical characteristics, resource use, and costs. 3M Health Information Systems developed the system for HCFA. A way of classifying hospital outpatient procedures for reimbursement purposes that is similar to…

A term which specifically means “able to walk,” but which in health care refers to a person who is not bedridden. Thus a person who requires a wheel chair is ambulatory, and can come in for treatment and return home. Able to walk, thus descriptive of a patient not confined to bed. Related to a…