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21st Century Cures Act

Law promoting patient access to health data and medical innovation.

ADA (Americans with Disabilities Act)

A federal civil rights law that prohibits discrimination against individuals with disabilities in various areas, including employment, public accommodations, and government services. In healthcare, the ADA requires hospitals, clinics, and providers to offer accessible facilities, effective communication aids (like sign language interpreters), and reasonable accommodations to ensure patients with disabilities receive equitable care.

Patient Rights

Ability-to-Pay Programs

Healthcare assistance programs adjusting costs based on patient income and financial circumstances.

Insurance & Billing

Accountable Care Organization (ACO)

A network of doctors, hospitals, and other healthcare providers who voluntarily collaborate to offer coordinated, high-quality care to Medicare patients. These groups aim to reduce healthcare costs by streamlining treatment and avoiding unnecessary procedures.

Patient Rights

Activities of Daily Living (ADLs)

Basic self-care tasks such as bathing, dressing, eating, and mobility. ADLs are used to assess an individual’s level of independence and the need for assistance or care services.

Healthcare Services

Administrative Simplification Provisions

HIPAA regulations standardizing electronic healthcare transactions.

Healthcare Access

Advance Care Planning

Process of discussing and documenting healthcare preferences for future medical decisions.

Patient Rights

Advance Directive

A legal document outlining a patient’s preferences for medical care if they become unable to make decisions. It typically includes a living will and healthcare proxy.

Patient Rights

Adverse Drug Reaction

Harmful or unintended response to medication at normal doses requiring medical attention.

Medical Procedures

Affordable Care Act (ACA)

A healthcare reform law designed to expand insurance coverage and regulate the insurance industry. Key provisions include protections for pre-existing conditions and the creation of health insurance marketplaces.

Healthcare Access

Age Discrimination in Health Care

Unfair treatment of patients based on age affecting access to medical services.

Patient Rights

Aging in Place

The ability of older adults to live independently in their homes with necessary support services. Aging in place allows seniors to maintain their routines and comfort while receiving medical or personal care as needed.

Healthcare Facilities

Allowed Amount

The maximum payment amount an insurance company agrees to pay for a specific covered healthcare service.

Insurance & Billing

Alternative Medicine Approaches

Non-conventional healthcare practices and therapies used alongside or instead of traditional Western medicine.

Healthcare Technology

Alternative Medicine Approaches

Non-conventional treatments used alongside or instead of traditional medical treatments.

Medical Procedures

Ambulance Fee Schedule

Standardized payment rates for emergency medical transportation services covered by insurance plans.

Insurance & Billing

Ambulatory Care

Medical services provided on outpatient basis including diagnosis treatment and preventive services without hospital admission or overnight stay.

Healthcare Services

Anatomical Gift Declaration

Legal document specifying organ donation wishes after death for transplantation.

Patient Rights

Annual Out-of-Pocket Maximum

The maximum amount you pay for covered healthcare services during a policy year before insurance covers 100% of costs.

Insurance & Billing

Anti-Microbial Resistance

Ability of microorganisms to resist medications making infections harder to treat.

Medical Procedures

Artificial Intelligence in Medical Diagnosis

Computer systems analyzing medical data to assist healthcare providers in detecting diseases predicting outcomes and personalizing treatment plans.

Healthcare Technology

Asset Spend-Down

Process of reducing assets to qualify for Medicaid long-term care benefits following specific rules.

Insurance & Billing

Assignment

An agreement by healthcare providers to accept Medicare’s approved payment amount for services or products as full payment. Providers who accept assignment cannot charge patients more than Medicare's deductible and coinsurance.

Insurance & Billing

Assisted Living vs. Nursing Home

Assisted living provides housing and support with daily activities, while nursing homes offer 24/7 medical care for those with serious health conditions. Assisted living is suited for those needing minimal assistance, whereas nursing homes cater to individuals requiring continuous medical supervision.

Healthcare Facilities

Authorization for Release of Medical Information

Written consent allowing healthcare providers to share medical records with designated parties.

Patient Rights

Balance Billing

When a provider bills a patient for the difference between their charge and what the insurance reimburses. Some states have laws protecting patients from balance billing in certain situations.

Insurance & Billing

Behavioral Health Services

Comprehensive treatment options for mental health conditions and substance use disorders including therapy medication management and support.

Healthcare Services

Beneficiary

A person who receives benefits from a health insurance plan, Medicare, Medicaid, or other healthcare programs. Beneficiaries include policyholders, dependents, and individuals enrolled in government health programs.

Insurance & Billing

Benefit Period

A defined window of time that Medicare uses to track your hospital and skilled nursing facility stays. It starts the day you’re admitted as an inpatient and ends after 60 consecutive days without inpatient care.

Insurance & Billing

Bioethics Principles

Ethical guidelines governing healthcare decisions including autonomy beneficence and justice.

Patient Rights

Biomarker Testing

Laboratory analysis identifying biological markers for disease diagnosis and treatment selection.

Medical Procedures

Birthing Center

Homelike facilities staffed by midwives and other healthcare providers offering prenatal care delivery and postpartum services with minimal medical intervention.

Bundled Payments

Single comprehensive payment covering all services related to specific treatment episode or condition.

Insurance & Billing

COBRA Insurance

A program that allows individuals to continue employer-sponsored health coverage after job loss for a limited time. COBRA can be expensive since the individual must pay the full premium, but it provides continuity of care.

Insurance & Billing

CPR Guidelines

Cardiopulmonary resuscitation (CPR) is a life-saving technique used in emergencies when someone's breathing or heartbeat has stopped. Updated guidelines emphasize hands-only CPR for bystanders to increase survival rates.

Medical Procedures

Capitated Payment Model

Healthcare reimbursement system paying providers fixed amount per patient regardless of services provided.

Insurance & Billing

Capitation

A fixed payment arrangement where healthcare providers receive a set amount per patient regardless of services rendered.

Insurance & Billing

Cardiac Rehab

A medically supervised program that helps individuals recover after a heart attack, surgery, or other heart conditions. It includes exercise training, education, and lifestyle changes to improve cardiovascular health.

Medical Procedures

Care Coordination

Organizing patient care activities between multiple providers.

Healthcare Access

Care Credit

Specialized credit card for healthcare expenses offering promotional financing for medical treatments.

Insurance & Billing

Caregiver Support Services

Resources helping family members care for ill or disabled individuals.

Healthcare Access

Case Management

Process to coordinate healthcare services meeting individual patient needs.

Healthcare Access

Catastrophic Health Insurance

A type of health plan designed for young or low-income individuals that covers emergency care and serious medical events. These plans have low premiums but very high deductibles, making them suitable only for worst-case scenarios.

Insurance & Billing

Certificate of Coverage

Legal document detailing your health insurance policy terms benefits covered services and cost-sharing requirements.

Insurance & Billing

Certificate of Need Laws

State regulations requiring approval for new healthcare facilities.

Healthcare Access

Certification of Medical Necessity

Provider documentation justifying specific treatments or equipment as essential for patient care.

Insurance & Billing

Charge Description Master

Comprehensive hospital price list detailing charges for every service procedure and supply item.

Insurance & Billing

Charity Care Application Process

Procedure for requesting free or reduced-cost medical services based on financial need documentation.

Insurance & Billing

Charity Care Programs

Hospital and healthcare provider programs that offer free or reduced-cost care to low-income individuals. These programs help ensure that financial hardship does not prevent access to essential medical treatments.

Insurance & Billing

Chart of Accounts in Healthcare

An organizational tool listing all accounts in a healthcare organization's accounting system that categorizes financial transactions for reporting and analysis.

Healthcare Technology

Chronic Care Management

Coordinated healthcare services for patients with multiple chronic conditions focusing on comprehensive care planning and monitoring.

Healthcare Services

Claim Denial

Insurance company decision refusing payment for a healthcare service with explanation and appeal rights information.

Insurance & Billing

Clinical Laboratory Improvement Amendments (CLIA)

Federal regulations ensuring quality laboratory testing standards.

Clinical Pathways

Structured care plans for specific medical conditions.

Healthcare Access

Coinsurance

The percentage of medical costs a patient must pay after meeting their deductible, such as paying 20% while insurance covers the remaining 80%. Unlike a copay, which is a fixed fee per visit or service, coinsurance is a percentage of the total cost, meaning the patient’s expense varies based on the price of the service.

Insurance & Billing

Collection Agency Practices for Medical Debt

Rules governing how third-party collectors pursue unpaid healthcare bills while protecting patient rights.

Community Benefits

Programs and services nonprofit hospitals provide to improve community health as tax-exemption requirement.

Insurance & Billing

Community Health Center

Nonprofit facilities providing comprehensive primary care services to medically underserved populations regardless of ability to pay.

Healthcare Facilities

Compassionate Use Programs

FDA pathways allowing access to experimental treatments for seriously ill patients.

Patient Rights

Competitive Bidding Programs

Process where healthcare suppliers compete to provide Medicare equipment and supplies at lowest prices.

Insurance & Billing

Complementary and Alternative Medicine

Non-conventional healthcare approaches used alongside or instead of traditional Western medicine including acupuncture herbal remedies massage.

Healthcare Services

Concierge Medicine

A healthcare model where patients pay a membership fee for enhanced access to their doctor, often including longer appointments, same-day scheduling, and more personalized care. This model reduces patient load per physician, allowing for more direct communication and comprehensive management, but it typically operates outside traditional insurance networks.

Healthcare Services

Conditions of Participation (Medicare)

Requirements facilities must meet to receive Medicare reimbursement.

Healthcare Access

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Federal law allowing temporary continuation of employer health coverage after qualifying events like job loss.

Insurance & Billing

Continuing Care Retirement Community

Residential campuses offering a spectrum of care from independent living to assisted living and skilled nursing as residents' needs change.

Healthcare Facilities

Continuity of Care Document

Standardized electronic summaries of patient health information designed to be shared between different healthcare providers to improve care coordination.

Healthcare Technology

Controlled Substances Act

Federal law regulating certain drugs based on abuse potential.

Healthcare Access

Coordination of Benefits

A process used when a patient has multiple health insurance policies to determine which insurer pays first. This helps avoid overpayments or gaps in coverage.

Insurance & Billing

Coordination of Benefits Agreement

Rules determining primary and secondary insurance coverage when patient has multiple health plans.

Insurance & Billing

Copayment (Copay)

A fixed amount a patient pays for a covered service, such as $30 for a doctor’s visit, regardless of the total cost of care. Unlike coinsurance, which is a percentage of the total bill and can vary based on the service's price, a copay remains a set fee, making healthcare expenses more predictable.

Insurance & Billing

Cost-Based Reimbursement

Payment method covering provider's actual costs plus margin rather than fixed service rates.

Insurance & Billing

Cost-Effectiveness Analysis

Evaluation comparing healthcare intervention costs to health outcomes for resource allocation decisions.

Insurance & Billing

Cost-Sharing Reduction

Discounts lowering out-of-pocket healthcare costs for eligible low-income individuals with marketplace insurance plans.

Insurance & Billing

Creditable Prescription Drug Coverage

Prescription drug insurance that provides at least the same value and coverage as Medicare's standard drug plans. Examples include insurance from employers, unions, TRICARE, VA, Indian Health Service, or private individual plans.

Healthcare Services

Crisis Hotline (988)

A nationwide, three-digit suicide and crisis hotline providing immediate support for individuals experiencing emotional distress. Callers can connect with trained counselors for mental health assistance at any time.

Chronic Conditions

Critical Access Hospital

A small, rural hospital that provides limited inpatient and outpatient services, specifically designed to give essential healthcare in areas without nearby larger hospitals. They are typically located over 35 miles from other hospitals and focus on short-term inpatient care of four days or fewer.

Healthcare Facilities

Cultural Competency in Healthcare

Providers' ability to deliver respectful effective care to patients from diverse backgrounds.

Patient Rights

Day Surgery Center

Healthcare facilities specializing in same-day surgical procedures that don't require overnight hospitalization.

Healthcare Facilities

Death Certificate

Official document recording time cause and location of death required for legal purposes.

Patient Rights

Deductible

The amount a patient must pay for medical services before insurance starts covering costs. High-deductible plans often have lower premiums but require more upfront spending before coverage kicks in.

Insurance & Billing

Demonstrations

Temporary experimental projects, also known as pilot programs or research studies, designed to evaluate new ways to improve Medicare services, payments, or quality of care. These programs usually have defined durations and are limited to specific participants or regions.

Healthcare Access

Detoxification Facility

Specialized treatment centers that help individuals safely withdraw from drugs or alcohol under medical supervision.

Healthcare Facilities

Diagnosis-Related Group (DRG) Payment

Fixed payment system for hospital inpatient services based on diagnosis categories regardless of actual costs.

Insurance & Billing

Dialysis Center

Outpatient facilities that provide kidney dialysis treatments for patients with end-stage renal disease to filter waste from their blood.

Healthcare Facilities

Digital Health Technology

Electronic tools and systems that collect analyze and share health information to improve patient care delivery and outcomes.

Healthcare Technology

Direct Primary Care (DPC)

A healthcare model where patients pay a flat monthly or annual fee directly to their primary care provider for unlimited visits and services, bypassing traditional insurance. Unlike concierge medicine, DPC generally has lower fees and focuses on affordability, often catering to individuals and families seeking routine care without the complexity of insurance billing.

Healthcare Services

Disability Insurance

Coverage providing income replacement when unable to work due to illness or injury with short-term or long-term benefits.

Insurance & Billing

Discharge Summary

Clinical documents summarizing a patient's hospital stay including diagnosis procedures performed medications prescribed and follow-up instructions.

Healthcare Technology

Disease Management Programs

Structured approaches to managing chronic health conditions.

Healthcare Access

Do Not Resuscitate (DNR) Order

A medical order stating that a patient does not want CPR if their heart stops. This is commonly used for terminally ill patients who wish to avoid aggressive interventions.

Patient Rights

Drug Compounding

Customized preparation of medications to meet specific patient needs not available commercially.

Medical Procedures

Drug Interactions

The effect that occurs when two or more medications, supplements, or substances interact in a way that alters their effectiveness or causes unintended side effects. Some interactions can reduce a drug’s effectiveness, while others may increase the risk of harmful reactions, making it vital for healthcare providers to review a patient’s full medication list.

Medical Procedures

Drug Misuse and Abuse

Inappropriate use of medications including overuse underuse or using for non-medical purposes.

Medical Procedures

Drug Side Effects

Unintended reactions that occur when taking a medication, ranging from mild issues like drowsiness or nausea to severe complications such as organ damage or allergic reactions. While some side effects are expected and manageable, others may require adjusting the dosage, switching medications, or stopping treatment altogether.

Medical Procedures

Dual Eligible Special Needs Plans

Medicare Advantage plans designed for individuals qualifying for both Medicare and Medicaid benefits.

Insurance & Billing

Durable Medical Equipment (DME)

Medical devices and supplies prescribed for long-term use, such as wheelchairs, oxygen tanks, and diabetic monitors. DME is frequently covered by insurance if deemed medically necessary, but it often needs to meet strict approval guidelines.

Healthcare Technology

Durable Power of Attorney

A document granting someone legal authority to make healthcare decisions if the patient is incapacitated. This person can make treatment choices on the patient’s behalf.

Patient Rights

EHR vs. EMR

EHRs (Electronic Health Records) are digital versions of patient records that can be securely shared across multiple healthcare providers and facilities, improving coordination between doctors, hospitals, and specialists. EMRs (Electronic Medical Records) are similar but limited to a single provider’s office or healthcare system, meaning they do not easily transfer between different medical organizations.

Healthcare Technology

Electronic Signature for Medical Records

Digital authentication methods that replace handwritten signatures in healthcare documentation ensuring security and compliance with healthcare regulations.

Healthcare Technology

Emergency Medical Services (EMS)

Coordinated system of first responders ambulances and medical professionals providing immediate care for sudden illness or injury.

Healthcare Services

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21st Century Cures Act

ADA (Americans with Disabilities Act)

Ability-to-Pay Programs

Accountable Care Organization (ACO)

Activities of Daily Living (ADLs)

Administrative Simplification Provisions

Advance Care Planning

Advance Directive

Adverse Drug Reaction

Affordable Care Act (ACA)

Age Discrimination in Health Care

Aging in Place

Allowed Amount

Alternative Medicine Approaches

Alternative Medicine Approaches

Ambulance Fee Schedule

Ambulatory Care

Anatomical Gift Declaration

Annual Out-of-Pocket Maximum

Anti-Microbial Resistance

Artificial Intelligence in Medical Diagnosis

Asset Spend-Down

Assignment

Assisted Living vs. Nursing Home

Authorization for Release of Medical Information

Balance Billing

Behavioral Health Services

Beneficiary

Benefit Period

Bioethics Principles

Biomarker Testing

Birthing Center

Bundled Payments

COBRA Insurance

CPR Guidelines

Capitated Payment Model

Capitation

Cardiac Rehab

Care Coordination

Care Credit

Caregiver Support Services

Case Management

Catastrophic Health Insurance

Certificate of Coverage

Certificate of Need Laws

Certification of Medical Necessity

Charge Description Master

Charity Care Application Process

Charity Care Programs

Chart of Accounts in Healthcare

Chronic Care Management

Claim Denial

Clinical Laboratory Improvement Amendments (CLIA)

Clinical Pathways

Coinsurance

Collection Agency Practices for Medical Debt

Community Benefits

Community Health Center

Compassionate Use Programs

Competitive Bidding Programs

Complementary and Alternative Medicine

Concierge Medicine

Conditions of Participation (Medicare)

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Continuing Care Retirement Community

Continuity of Care Document

Controlled Substances Act

Coordination of Benefits

Coordination of Benefits Agreement

Copayment (Copay)

Cost-Based Reimbursement

Cost-Effectiveness Analysis

Cost-Sharing Reduction

Creditable Prescription Drug Coverage

Crisis Hotline (988)

Critical Access Hospital

Cultural Competency in Healthcare

Day Surgery Center

Death Certificate