Healthcare Acronyms & Terms
This is a list of some of the more common acronyms and terms used across the healthcare system in Alaska, collated by AHHA and partner organizations as part of our Alaska Healthcare 101 educational series.
AADD – Alaska Association on Developmental Disabilities. The Alaska Association on Developmental Disabilities (AADD) was founded over 30 years ago to unify the voice of providers to share, develop and advocate for individualized community-based services for people who experience developmental disabilities.
AARP – Formerly American Association of Retired Persons, now just AARP. AARP is the nation's largest nonprofit, nonpartisan organization dedicated to empowering people to choose how they live as they age. AARP Alaska has more than 82,000 members.
ABHA – Alaska Behavioral Health Association. ABHA is the trade organization representing behavioral health providers in the State of Alaska. It was formed in 1996 to help improve the delivery of substance abuse and mental health treatment services in Alaska. With leadership from over 60 community mental health and substance abuse treatment providers across the state, ABHA offers a diverse perspective with the common interest of providing access to the best quality, cost-effective behavioral health treatment available.
ACA - Affordable Care Act of 2010
Also known as the Patient Protection and Affordable Care Act, ACA, along with the
changes included in the Health Care and Education Affordability Reconciliation Act
of 2010, constitutes comprehensive federal healthcare reform that aims to substantially
increase health insurance coverage of Americans, end some insurance company
abuses, reduce healthcare costs and improve care. The law includes far-reaching
changes for healthcare providers, including significant reductions in reimbursement
ACO – Accountable Care Organization
A network of healthcare providers that together manages and coordinates care for
patients along the continuum of care. The network is held accountable for the quality
and cost of care, and may share the cost savings achieved.
ADLs – Activities of Daily Living
Activities performed as part of a person’s daily routine of self-care, such as bathing,
dressing, eating, etc.
Admissions (Admits) - Patients admitted in a hospital or inpatient facility for an overnight stay during a particular period.
AHEC – Area Health Education Center
A program to enhance medical services in under-served areas. AHEC focuses on the healthcare pipeline and health professional education through community-based training sites across Alaska.
AHHA - Alaska Hospital & Healthcare Association. For 70 years, AHHA has served as a non-profit trade association representing Alaska's hospitals, nursing homes, and other healthcare partners across the continuum of care. AHHA provides policy and advocacy expertise, leads and hosts opportunities for education and training, and brings together members and stakeholders for collaborative work to share data, resources, and best practices.
APCD - All payer claims database would expand the pool of healthcare claims data to include commercial plans
ACL- Administration for Community Living
ADA, as Amended by WIOA: Americans with Disabilities Act (signed July 26, 1990), amended by the Workforce Innovation and Opportunities Act (July 22, 2014)
Alaska Healthcare Transformation Project – In Spring, 2017 a small group met in Juneau to see if there was an avenue to bring together collective knowledge and begin work on a comprehensive healthcare plan for Alaska. A Project Management Committee provides overall direction, guidance and support to the project, and monitors the project to ensure successful delivery of expected outputs and outcomes within scope and budget.
ALF – Assisted Living Facility
A senior living option that combines housing, support services and healthcare as
needed. Designed for individuals who require assistance with ADLs.
Ambulatory Care – Healthcare services that do not require the hospitalization of a patient. These services include outpatient care at a hospital and care provided at a physician’s office,
clinic, or other facility.
APCA – Alaska Primary Care Association. APCA advocates for health policy for Alaskans, provides technical training and assistance to Community Health Centers, and teaches and supports the rising generation of Community Health Workers. APCA is an organization with the mission to create healthy communities in Alaska through the support of vibrant and effective Community Health Centers.
ASC – Ambulatory Surgery Center
An independently licensed entity providing elective surgery on an outpatient, walk-in
or same-day basis.
ASMA - Alaska State Medical Association
ASO – Administrative Services Organization
A managed care administrative entity that performs certain tasks. An ASO is not an insurance plan and is not licensed to sell insurance. In Alaska Optum is the ASP for Medicaid Behavioral Health services.
Balance Billing – A provider’s billing of a covered person directly for charges above the amount reimbursed by the health plan (i.e., difference between billed charges and the amount
paid). This may or may not be allowed, depending upon state regulations and the contractual arrangements between the parties.
CAH – Critical Access Hospital
A federal designation that enables essential rural hospitals to downsize while
continuing to provide key services in affiliation with a full-service acute care
hospital.
CHNA – Community Health Needs Assessment
Section 501(r) of ACA requires hospitals to conduct a Community Health Needs
Assessment every three years and adopt an implementation strategy to meet the
community health needs identified.
CNA – Certified Nurse Aide
An individual certified to perform nurse assistant duties under the supervision of a
nurse.
CIL- Center for Independent Living
CIN - clinically integrated network - a selective partnership of physicians collaborating with hospitals to deliver evidence-based care, improve quality, efficiency, and coordination of care, and demonstrate value to the market.
CME – Continuing Medical Education
Education for medical professionals (i.e., a physician learns new medical techniques
or technologies).
Centers for Medicare and Medicaid Services (CMS)—The agency in the Department of Health and Human Services with responsibility for administering the Medicaid, Medicare, and State Children’s Health Insurance programs (CHIP) at the federal level. Formerly known as the Health Care Financing Administration (HCFA).
CON – Certificate of Need
A regulation that requires state approval of medical care facility construction, initiation of new healthcare services, addition of hospital or nursing home beds and purchase of major medical equipment.
DRGs – Diagnosis-Related Groups
A method for classifying patients in categories according to patient diagnosis and treatment resource requirements. It is the basis for CMS’ hospital Prospective Payment System for Medicare and for state Medicaid inpatient reimbursement. Alaska is transitioning larger hospitals to APR-DRGs – All Patient Refined Diagnosis Related Groups payment system for Medicaid.
DSP - Direct Support Professional - a person hired to provide assistance to a person with a disability. Assistance may be hands-on/physical care or prompting/coaching.
ED/ER – Emergency Department/Emergency Room
A medical treatment facility specializing in emergency medicine and the acute care of patients who present without prior appointment, either by their own means or by that of an ambulance. The ED is usually found in a hospital or other primary care center.
EHR – Electronic Health Record
A medical record or any other information relating to a patient’s physical and mental health, which resides in computers that capture, transmit, receive, store, retrieve, link and manipulate medical data for the primary purpose of providing healthcare and health-related services. EHRs include patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.
ERISA - Employee Retirement Income Security Act -is a federal law that created rules and procedures to protect most private employee pension and health plans from fraud and mismanagement.
EMS – Emergency Medical Services
An integrated, federally assisted system of health manpower, facilities and equipment providing all necessary emergency care in a defined geographic area.
EMTALA – Emergency Medical Treatment and Labor Act
Enacted in 1986, this federal law requires hospitals to assess whether a patient has an emergency condition and, if so, to stabilize it.
Essential Health Benefits
Essential health benefits are a set of ten categories of services health insurance plans must cover under ACA, including doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth and mental health services.
FEHB – Federal Employees Health Benefits program provides coverage for federal employees and contractors.
FEMA – Federal Emergency Management Agency
An independent agency of the federal government whose mission is to reduce loss of life and property and protect the nation’s critical infrastructure from all types of hazards through a comprehensive, risk-based, emergency management program.
FMAP – Federal Medical Assistance Percentage
The federal government matches state Medicaid spending for specified categories of people and benefits, based on the FMAP formula, which compares each state’s per capita income to the national average.
FQHC’s - Federally Qualified Health Centers
A type of provider defined by the Medicare and Medicaid statutes, including all organizations receiving grants under Section 330 of the Public Health Service Act, certain tribal organizations and FQHC look-alikes. FQHCs must provide primary care services for all age groups and must provide preventive health services onsite or by arrangement with another provider.
GCDSE- Governor’s Council on Disabilities and Special Education
GME – Graduate Medical Education
Medical education after receiving the medical doctorate or equivalent degrees, including education received as an intern, resident or fellow.
HCBS- Home and Community Based Services
HPUD -health payment and utilization database will collect and analyze healthcare claims from Medicaid, Medicare, state employees, and fully insured plans
HHS – Department of Health and Human Services
The federal agency that administers most federal health programs, including Medicare.
HIE – Health Information Exchange
Provides the capability to electronically move clinical information among disparate healthcare information systems to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
HIPAA – Health Insurance Portability and Accountability Act of 1996
Federal law that governs privacy, security and electronic transaction standards for healthcare information, while also protecting an individual’s right to health coverage during events such as changing or losing jobs, pregnancy, moving or divorce.
HPSA – Health Professional Shortage Area
Areas identified by HRSA as having shortages of primary medical care, dental or mental health providers. The areas may be geographic (e.g., a county or service area), demographic (e.g., low-income population) or institutional (e.g., comprehensive health center, federally qualified health center or other public facility).
HRSA – Health Resources and Services Administration
A federal agency that directs national health programs ensuring quality healthcare to under-served, vulnerable and special-need populations and promotes appropriate health professions workforce capacity and practice.
ICD 10-CM – International Classification of Disease, Tenth Revision, Clinical Modification
A classification system that groups related diseases and procedures for the reporting
of statistical information. Maintenance of the system is shared by CMS and NCHS.
ICF – Intermediate Care Facility
A federal classification of institutions recognized under the Medicaid program that provide health-related services to individuals who need care in an institutional facility but do not require the degree of care that a hospital or SNF is designed to provide.
ICU – Intensive Care Unit
A nursing unit specially equipped for monitoring and treating seriously ill patients.
I/DD - Intellectual and/or developmental disability. To qualify for I/DD services, a person must be diagnosed with a lifelong disability before the age of 22.
ILN- Independent Living Network
LTC – Long-Term Care
Continuous or recurring care provided for a chronic illness.
Medicaid
A joint federal and state healthcare assistance program for low-income persons of any age and some people with long-term disabilities.
Medical Home
A model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team, which also may include roles for NPs or PAs, is responsible for providing all the patient’s healthcare and, when needed, arranges for appropriate care with other qualified physicians.
Medicare
A federally-sponsored health insurance program for those aged 65 and over, and
certain other eligible individuals. It has four parts: Part A covers inpatient costs;
Part B covers outpatient costs; Part C is the Medicare+Choice program; and Part D
covers prescription drugs.
Prior Authorization— A mechanism that state Medicaid agencies may at their option use to control use of covered items (such as durable medical equipment or prescription drugs) or services (such as inpatient hospital care). When an item or service is subject to prior authorization, the state Medicaid agency will not pay unless approval for the item or service is obtained in advance by the beneficiary’s treating provider, either from state agency personnel or from a state fiscal agent or other contractor.
Olmstead – Olmstead vs L.C. decided by Supreme Court in1999, the decision held that persons with disabilities have a qualified right to receive state funded supports and services in the community rather than institutions
PCA – Personal Care Assistant
A person who assists in caring for patients in hospitals, nursing homes, clinics and institutions for older adults or people with disabilities. Tasks include assisting nursing staff to lift and turn bedridden patients and helping patients with ADLs.
PCP – Primary Care Physician
A doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions.
PHI – Protected Health Information
Any information about health status, provision of healthcare or payment for healthcare that can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient’s medical record or payment history.
PPE – Personal Protective Equipment
Creates a barrier to protect an individual from exposure to toxins, biological organisms or hazardous materials.
PPO – Preferred Provider Organization
A payment arrangement in which employers or insurers contract with hospitals or physicians on a negotiated FFS basis to provide healthcare services. Subscribers can select any provider for care, but they are given economic or other incentives to use designated hospitals or physicians.
RRC – Rural Referral Center
A Medicare designation for a rural tertiary hospital that receives referrals from surrounding
small primary care hospitals. An acute care hospital can be classified as an RRC if it meets several criteria pertaining to location, bed size and referral patterns.
SILC – Statewide Independent Living Council
Section 1115 Waiver – Section 1115 of the Social Security Act allows the Secretary of Health and Human Services to authorize experimental, pilot or demonstration projects that, in the judgment of the Secretary, are likely to promote the objectives of the Medicaid statute.
SNF – Skilled Nursing Facility
A residential healthcare facility providing care to a primarily elderly population requiring high levels of medical, social and/or rehabilitation services.
TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) - provides access to Medicaid services for children under 19 years of age with significant medical, developmental or psychological disabilities.