Glossary
Glossary
These words, phrases, and acronyms can help you use our products.
- 1500 claims
A type of claim form used for billing.
- 835 Remittance
An electronic transaction that provides claim payment information to agencies.
- 837 File
An electronic file containing resident claims providers submit to payers for reimbursement.
- Activities of Daily Living (ADLs)
Activities needed for self-care: bathing, dressing, mobility, toileting, eating, and transferring.
- Advance Directive
A legal document related to life-sustaining treatments, prepared by the resident or representative when the resident is competent and able to make decisions. The advance directive informs the medical personnel about the treatment and care preferences if the resident becomes incapacitated.
- Alert
A notification triggered or created to alert staff of a change in a resident's condition or status.
- Allergy
Exposure to a substance that causes the immune system to react abnormally.
- Allowed list ()
A list of items, such as emails or IP addresses, granted access to a certain system or protocol. All entities are denied access, except those included in the allowed list. An outdated term for this is blacklist.
- American Health Information Management Association (AHIMA)
An association of health information management (HIM) professionals worldwide.
- Application Program Interface (API)
An application programming interface defines the interaction between systems and provides a seamless integration and exchange of information between them.
- Assessments
The evaluation of the needs and abilities of a resident based on observation, tests, and performance.
- Automated Survey Processing Environment (ASPEN)
A suite of software products to help State Agencies collect and manage healthcare provider data.
- Billing Account Record (BAR)
In the HL7 standard, BAR messages add or change the resident's billing account information.
- Care at Home (CAH)
The mobile app for Home Health from PointClickCare.
- Care Plan
Measurable objectives and timetables to meet a resident’s needs and provide direction for individualized care.
- Care Record
A document containing the interventions used to meet the resident's needs.
- Centers for Medicare/Medicaid Services (CMS)
A federal agency within the United States Department of Health and Human Services.
- Certification and Survey Provider Enhanced Reports (CASPER)
Reports to know where the agency stands in regard to its 5 star rating, Quality Measures, and more.
- CMS Certification Number (CCN)
The Medicare Provider Number for a agency.
- Code of Federal Regulations (CFR)
A codification of the general and permanent rules published in the Federal Register by the Executive departments and agencies of the Federal Government. The CFR is divided into 50 titles that represent broad areas subject to Federal regulation. Each title is divided into chapters that usually bear the name of the issuing agency. Each chapter is further subdivided into parts covering specific regulatory areas. Large parts may be subdivided into subparts. All parts are organized in sections, and most citations to the CFR will be provided at the section level.
- Community Health Accreditation Program (CHAP)
An independent, non-profit accrediting body that publicly certifies that an organization has voluntarily met the highest standards of excellence for home and/or community-based health care.
- Contact Type
Identifies the role for professional and resident contacts.
- Continuity of Care Document (CCD)
Document used to share summary information about a patient between providers within the broader context of the personal health record.
- Diagnosis
The identification of the nature of an illness or other problem by examination of the symptoms.
- Electronic Data Interchange (EDI)
Exchange of electronic business data in a standardized format between trading partners.
- Etiology
The cause(s) of a disease or condition that affects a resident.
- Fee for Service (FFS)
A payment model in which billing and payment for services are unbundled. This payment model incentivizes more treatments because payment depends on the quantity of care, rather than quality of care.
- Final Validation report (FVR)
- Healthcare Common Procedure Coding System (HCPCS)
Codes and descriptive terms used for reporting services and procedures to Medicare.
- Health Information Service Provider (HISP)
A HISP provides the backend technical work to securely send and receive your data transmissions and exchanges.
- Health Level-7 (HL7)
A set of international standards for transfer of clinical and administrative data between software applications.
- Home Assessment Validation and Entry System (HAVEN)
Standardized format for electronically creating OASIS data records to be sent to state agencies.
- Home Health (HH)
Medical care provided to clients in a home-based setting. This care is part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) ordered by a physician.
- Home Health Agency (HHA)
A company that provides home-based health care to clients.
- Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS)
A national survey of home health care patients' perspective of their skilled home care.
- Home Health Prospective Payment System (HHPPS)
Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country.
- Home Health Quality Initiative (HHQI)
A program from the Centers for Medicare & Medicaid Services (CMS) that provides evidence-based educational tools and resources to help you improve the quality of home health care provided.
- International Classification of Diseases (ICD)
ICD-10 codes are alphanumeric codes developed by the World Health Organization (WHO) used by doctors, health insurance companies, and public health agencies across the world to represent diagnoses.
- Low-Utilization Payment Adjustment (LUPA)
LUPA occurs when 4 or fewer visits are provided in a 60 day episode. Instead of payment being based on the Health Insurance Prospective Payment System (HIPPS) code, payment is based on a national standardized per visit payment by discipline instead of an episode payment for a 60 day period.
- Management Minutes Questionnaire (MMQ)
A tool used to assess a resident's condition over a period of time as designated by each question. This tool is used in the state of Massachusetts.
- Master Data Management (MDM)
Software allowing IT administrators to
configure security policies on the MDM server and push the policies to managed devices such as smartphones, tablets, and other endpoints.
deploy applications to managed devices through the MDM server.
- Medicare Administrative Contractor (MAC)
A private health care insurer that is awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
- Medicare Beneficiary Identifier (MBI)
Replaces the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.
- National Healthcare Safety Network (NHSN)
The Centers for Disease Control and Prevention (CDC)'s most widely used healthcare-associated infection tracking system.
- National Pressure Ulcer Advisory Panel (NPUAP)
Coordinates the development of a uniform terminology, test methods, and reporting standards for support surfaces. The guidelines provide objective methods for evaluating and comparing support surface characteristics.
- National Provider Identifier (NPI)
A unique 10-digit identification number issued to health care providers by the Centers for Medicare and Medicaid Services (CMS).
- National Quality Forum (NQF)
A membership organization that promotes patient protections and healthcare quality through measurement and public reporting.
- Outcome and Assessment Information Set (OASIS)
A group of standard data elements. The OASIS contains data elements developed for measuring patient outcomes for performance improvement.
- Partial Episode Payment (PEP)
A payment adjustment made when a client transfers to another HHA or is discharged and readmitted to the same HHA during the 60 day episode.
- Payroll Based Journal Entry (PBJ)
Reporting required under Section 6106 of the Affordable Care Act (ACA). Under the ACA, long term care facilities must submit information about staff working in direct care.
- Pick Lists
A configurable list of terms that appear in the product user interface. The items in the lists are customized to the specific needs of an organization or agency.
- Plan of Care/485
Used by agencies that require physician approval for the plan of care every 60 days.
- Preferred Provider Organization (PPO)
A managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
- PRN
As needed. For example, PRN medications, treatments, tasks, or interventions that are documented as needed.
- Prospective Payment System (PPS)
A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.
- Provider Enrollment and Chain/Ownership System (PECOS)
The electronic portal through which providers enroll in Medicare.
- QShift
Every shift. For example, QShift medications, treatments, tasks, or interventions that must be documented every shift.
- Quality Assessment Only (QAO)
Pay-for-reporting performance requirement measured through the use of a simple formula. Only those OASIS assessments that contribute, or could contribute, to creating a quality episode of care are included in the calculation.
- Quality Assurance Performance Improvement (QAPI)
A systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality.
- Quality Improvement and Evaluation System (QIES)
The CMS system for survey and certification of providers.
- Quality Reporting Program (QRP)
A set of health home quality measures. These quality and utilization measures are used for ongoing monitoring and evaluation purposes across all state health home programs.
- Quick Reference Guide (QRG)
A short document to support you in complex or infrequent tasks. Not intended to provide every step in a process.
- Regional Home Health Intermediaries (RHHI)
A private company that contracts through Medicare to pay bills under the guidelines of original Medicare. RHHIs also investigate the quality of home health care services.
- Regional Office (RO)
An office that is in charge of several local offices or agencies in 1 geographic area.
- Request for Anticipated Payment (RAP)
The first bill sent to Medicare that is usually billed at the beginning of a certified home health episode.
- Resumption of Care (ROC)
An assessment completed on a Home Health patient following an inpatient facility stay of 24 hours or longer for reasons other than diagnostic testing.
- Security roles
Determines access in Home Health Care.
- Security User
A security account allowing the user to log in to Home Health Care. Also called user account.
- Significant Change in Condition (SCIC)
A major decline or improvement in a resident’s status that does not normally resolve itself without intervention.
- Skilled Nursing Facility (SNF)
A long-term care facility for residents who require post-acute care.
- Start of Care (SOC)
An assessment completed when a patient is admitted to a home health agency.
- Structured Progress Note (SPN)
You can build Structured Progress Notes (SPNs) in the Custom Assessments Library, including assessment responses, resident profile information, scores, and score categories. The SPN information pushes to the Prog Note tab of a resident's chart on completion of the assessment.
- Uniform Billing Form (UB-04)
The standard form used to bill medical claims.
- Wound Ostomy Continence Nurses Society (WOCN)
A professional international nursing society of more than 5,000 health care professionals who are experts in the care of patients with wound, ostomy, and incontinence.