Home & Community-Based Services. Within broad Federal guidelines, States can develop home and community-based services waivers to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting.

The final rule establishes that the provisions adopted in this this final rule will be in effect during 2021 and that most provisions will be applicable to coverage that begins January 1, 2022. The changes finalized in this rule are expected to result in an estimated $75.4 million savings to(...)

Accountable Care Organization

Adverse Drug Event

ADT response message.

Adverse Drug Reaction

Admission, Discharge and Transfer.

American Hospital Association

Assisted Living

Average Length of Stay

American Medical Association

American Medical Directors Association. AMDA was officially chartered in June, 1977 and is now known as the Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners,(...)

American National Standards Institute. Founded in 1918, ANSI itself does not develop standards. ANSI’s roles include serving as the coordinator for U.S. voluntary standards efforts, acting as the approval body to recognize documents developed by other national organizations as American(...)

All Payer Claims Database

Application Programming Interface

All Payer Model

Alternative Payment Model. Under MACRA, if clinicians decide to take part in an Advanced APM, they may earn a Medicare incentive payment for sufficiently participating in an innovative payment model. It is a payment approach that gives added incentive payments to provide high-quality and(...)

APM Performance Pathways

AUA Quality (AQUA) Registry. Recognized by CMS as a Qualified Clinical Data Registry (QCDR)

Accredited Standards Committee X12. ASC X12 develops standards for electronic data interchange, is administered by the Data Interchange Standards Association (DISA), and is accredited to submit its documents to ANSI for approval as American National Standards. X12 has developed a number of(...)

Automated Survey Processing Environment

American Urological Association

Business Associate Agreement

Business Development

Business Intelligence

Book Of Business

Blood Pressure

Benign Prostatic Hyperplasia

Consolidated CDA (Clinical Document Architecture)

Consolidated Appropriations Act. Established a new Medicare type in 2021 of Rural Emergency Hospitals (REH).

Critical Access Hospital

Consumer Assessment of Healthcare Providers and Systems

Council for Affordable Quality Healthcare (commonly referred to as “C-A-Q-H”)

Certification and Survey Provider Enhanced Reports

Community Based Organization

Congressional Budget Office

Continuity of Care Documents are a type of electronic document that summarize patient information and help providers communicate clinical information during transitions of care.

Clinical Context Object Workgroup

Center for Clinical Standards and Quality at CMS.

Critical Care Unit

Clinical Document Architecture

Centers for Disease Control and Prevention

Clinical Data Exchange

Clinical Data Model

Clinical Decision Support. Typically used when referring to a type of system that assists health care providers in making medical decisions. These types of systems typically require input of patient-specific clinical variables and as a result provide patient-specific recommendations.

Community Health Access and Rural Transformation Model. CMS aims to continue addressing disparities by providing a way for rural communities to transform their health care delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities.

Certified HEDIS Compliance Auditor (NCQA)

Community Integrated Medical Home Program

Community Living Assistance Services and Supports Act. A voluntary public long-term care insurance program. The Obama administration decided not to implement CLASS in November 2011 after actuaries concluded the program would not be financially self-sustaining. Congress formally repealed CLASS(...)

Community Mental Health Center

CMS Center for Medicare and Medicaid Innovation

Centers for Medicare & Medicaid Services

Certified Nursing Assistant

Certificate of Conformance

Certificate of Need

Conditions of Participation

CAQH Committee on Operating Rules and Information Exchange

Clinical Practice Guideline

Current Procedural Terminology

Clinical Quality Language

Clinical Quality Metrics Registry

Continuing Care Retirement Community. CCRC is a community living arrangement, typically on a single campus, that provides housing, health care, and social services. CCRCs offer different levels of services ranging from independent housing to nursing home care.

Chesapeake Regional Information System for Our Patients

Data Aggregator Validation

digital Clinical Quality Measure or digital Quality Measure

Digital Imaging and Communications in Medicine. Version 3 of DICOM defines image data as well as patient, study and visit information necessary to provide the context for the images. This version incorporates an object-oriented data

Doctor of Osteopathic Medicine

Director of Nursing

Date of Service

Data Quality Assessment

Digital Quality Ecosystem

Downstream-Related Entity

Diabetic Retinal Exam

Digital Rectal Exam

Diagnosis-Related Group

Evidence Based Programs

Electronic Clinical Data System

Electronic clinical quality improvement provides common standards and shared technologies to monitor and analyze the quality of healthcare provided to patients and patient outcomes.

electronic Clinical Quality Measure

Electronic Data Interchange

The Electronic Data Interchange For Administration, Commerce and Transport (EDIFACT) is a set of internationally agreed standards, directories, and guidelines for the electronic interchange of structured data related to trade in goods and services between independent computerized information(...)

Eligible Hospital

eHealth Initiative & Foundation (founded in 2001) conducts research, education and advocacy activities to promote data sharing and innovation to improve patient outcomes and the overall healthcare experience. eHI convenes executives from every stakeholder group in healthcare to discuss,(...)

Electronic Health Information

Electronic Health Records are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s(...)

Electronic Medical Records are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment. EMRs are(...)

Emergency Medical Services

Emergency Room or Emergency Department

Triage, Treat, Transport (CMS EMS demo)

Extract, Transform, and Load. The process of ETL plays a key role in data integration strategies. ETL allows businesses to gather data from multiple sources and consolidate it into a single, centralized location. ETL also makes it possible for different types of data to work together.

Frequently Asked Question

U.S. Food and Drug Administration

Food and Drug Administration Safety and Innovation Act of 2012 directed the Secretary of Health and Human Services, acting through the Commissioner of the U.S. Food and Drug Administration (FDA), and in consultation with ONC and the Chairman of the Federal Communications Commission, to develop(...)

Federal Electronic Health Record Modernization (military health). FEHRM’s primary mission is to implement a single, common federal EHR to enhance patient care and provider effectiveness, wherever care is provided.

Fee-for-Service

Fast Healthcare Interoperability Resources (pronounced “fire”)

Fast Healthcare Interoperability Resources + Clinical Quality Language

Federally Qualified Health Center

U.S. Government Accountability Office (GAO) is an independent, nonpartisan agency that works for Congress. Often called the "congressional watchdog," GAO examines how taxpayer dollars are spent and provides Congress and federal agencies with objective, reliable information to help the(...)

Graduate Medical Education

Globally Unique IDentifier is a 128-bit integer (16 bytes) that can be used across all computers and networks wherever a unique identifier is required. Such an identifier has a very low probability of being duplicated. The term Universally Unique Identifier (UUID) is also used. See UUID for(...)

Hierarchical Condition Category refers to a system of medical coding used by insurance companies to determine patients' future medical needs for the next year. Only life altering medical conditions are recorded in medical coding, such as a diabetes diagnosis, end stage renal disease, and others.

Health Care Improvement Foundation

Health Care Organization. Term used by The Joint Commission (TJC).

Healthcare Effectiveness Data and Information Set – The prevalent standard for the measurement of quality of care, managed and maintained by NCQA. HEDIS is a registered trademark of NCQA and should be referenced as such in any published materials.

Home Health Agency

U.S. Department of Health & Human Services

Health Information Exchange

Healthcare Information and Management Systems Society. A global advisor and thought leader supporting the transformation of the health ecosystem through information and technology.

Health Information Network

Health Insurance Portability and Accountability Act of 1996. Protects health insurance coverage for workers and their families when they change or lose their jobs, requires the establishment of national standards for electronic health care transactions, and requires establishment of national(...)

The Health Information Technology Advisory Committee was established in the 21st Century Cures Act and is governed by the provisions of the Federal Advisory Committee Act. Recommends to the National Coordinator for Health Information Technology, policies, standards, implementation(...)

The Health Information Technology for Economic and Clinical Health Act of 2009 provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic(...)

The Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act(...)

The Health Information Trust Alliance (HITECH) enables vendors and provider organization to demonstrate compliance with federal privacy requirements.

Health Level 7

Health Professional Shortage Area

Health Quality Measure Format is a standards-based representation of quality measures as electronic documents written in XML. It is developed by Health Level Seven International® (HL7), an American National Standards Institute (ANSI) accredited standards development organization. Since 2019,(...)

Health Quality Measure Format (HQMF) is a standards-based representation of quality measures as electronic documents written in XML. It is developed by Health Level Seven International® (HL7), an American National Standards Institute (ANSI) accredited standards development organization. Since(...)

Hospice Quality Reporting Program

Health Risk Assessment or Health Reimbursement Account

The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.

Health Services Cost Review Commission

Hypertext Transfer Protocol is a protocol with the lightness and speed necessary for a distributed collaborative hypermedia information system. It is a generic stateless object-oriented protocol, which may be used for many similar tasks such as name servers, and distributed object-oriented(...)

International Classification of Disease

Intensive Care Unit

Integrated Delivery Model

Integrated Delivery Network. An IDN is an organization or group of healthcare providers, which, through ownership or formal agreements, aligns local healthcare facilities and manages them with one governing board. They share a vision and mission of improving the quality of care and patient(...)

Interactive Data Submission System (NCQA HEDIS®)

Institute of Electrical and Electronics Engineers is accredited by ANSI to submit its documents for approval as American National Standards. IEEE subcommittee P1073 develops standards for healthcare informatics: MEDIX (P1157) and MIB (P1073).

Implementation Guide

Inpatient Prospective Payment System

internet Quality Improvement and Evaluation System. Beginning in 2020, State Survey Agencies will begin using an internet-based system for survey functions known as the iQIES to replace and consolidate functionality from the QIES, CASPER and ASPEN legacy systems.

Inpatient Quality Reporting. CMS collects quality data from hospitals.

Interim Final Rule

Initial Validation Audit

Journal of the American Medical Association

Job class/code data type. This contains the person's job code.

JavaScript Object Notation is an open standard file format, and data interchange format, that uses human-readable text to store and transmit data objects consisting of attribute–value pairs and array data types (or any other serializable value). It is a very common data format, with a diverse(...)

Kiser Healthcare Solutions

Kent Leonard Adam and Scott started KLAS Research in 1996. KLAS was founded with a desire to help providers, and now payers, find transparency in the healthcare IT marketplace.

Local-Area Network is a user-owned, user-operated, high-volume data transmission facility connecting a number of communicating devices (e.g., computers, terminals, word processor, printers, and mass storage units) within a single building or campus of buildings.

Low Income Subsidy

Line Of Business

Logical Observation Identifiers Names and Codes

Licensed Practical Nurse

Long-Term Care

Medicare Advantage

MidAtlantic Business Group on Health

The Medicare Access and CHIP Reauthorization Act of 2015 ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. If a provider participates in Medicare Part B, the Quality Payment Program. Provides tools(...)

Measure Advisory Panel

The Measure Authoring Tool is a web-based tool that allows measure developers to author electronic Clinical Quality Measures (eCQMs).

Managed Care Organization

Medical Degree or Doctor of Medicine

Medical Document Message.

Measure Expert Panel

Merit-based Incentive Payment System. If a MIPS eligible clinician, clinicians earn a performance-based payment adjustment through MIPS. Under MIPS, clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for(...)

Medical Loss Ratio. A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company(...)

Medicare Prescription Drug, Improvement, and Modernization Act.

Memorandum of Understanding

Medical Record Review

Medical Record Review Validation

Minimum Required Terms & Conditions: These are the mandatory terms and conditions that Qualified Health Information Networks (QHINs) voluntarily agree to follow. The Common Agreement would include the MRTCs, as well as additional required terms and conditions developed by an industry-based(...)

Management Services Organization: An organization that provides non-clinical services to providers to enhance revenues, contain costs, and improve quality.

Medicare Shared Savings Program is committed to achieving better health for individuals, better population health, and lowering growth in expenditures. The Shared Savings Program offers providers and suppliers (e.g., physicians, hospitals, and others involved in patient care) an opportunity to(...)

Medication Therapy Management

Founded in 1970 as the Institute of Medicine (IOM), the National Academy of Medicine is one of three academies that make up the National Academies of Sciences, Engineering, and Medicine (the National Academies) in the United States. Operating under the 1863 Congressional charter of the(...)

National Council On Aging

National Council for Prescription Drug Programs was founded in 1977 as the extension of a Drug Ad Hoc Committee that made recommendations for the US National Drug Code (NDC). NCPDP is a not-for-profit, ANSI-accredited, standards development organization representing most sectors of the(...)

National Committee for Quality Assurance

New Covid-19 Treatments Add-on Payment. Enables providers to bill for Covid-19 treatments available for emergency use or approved by FDA under IPPS.

National Drug Code

Natural Language Processing – Technology that automates the translation of natural languages (human) to machine languages (electronic/computer) using artificial intelligence and computational linguistics.

Notice of Funding Opportunity

National Quality Forum

Outcome and Assessment Information Set

Open Authorization. OAuth ("oh-auth") is an open standard for token-based authorization, access delegation. Commonly used as a way for Internet users to grant websites or applications access to their information on other websites but without giving them the passwords or the user's account(...)

The Observational Health Data Sciences and Informatics (pronounced "Odyssey") program is a multi-stakeholder, interdisciplinary collaborative to bring out the value of health data through large-scale analytics. All our solutions are open-source.

An object identifier is an unambiguous, long-term name for any type of object or entity. An OID appears as a group of characters that allows a server or end user to retrieve an object without needing to know the physical location of the data.

The Observational Medical Outcomes Partnership was a public-private partnership established to inform the appropriate use of observational healthcare databases for studying the effects of medical products. The OMOP common data model transforms observational health data into a common format(...)

Office of the National Coordinator

Out-of-Network - Providers that members use that submit claims to payers for reimbursement (i.e., providers that have clinical data about members where the access for the payer is not contractually defined)

Pay-for-Improvement

Pay-for-Performance

Pay-for- Reporting

Program of All-Inclusive Care for the Elderly

Post Anesthesia Care Unit

Post-Acute and Long-Term Care

Patient Activation Measure is a survey that assesses the knowledge, skills, and confidence integral to managing one's own health and health care. With the ability to measure activation and uncover related insights into consumer self-management competencies, care support and education can be(...)

Primary Care Collaborative

Patient Centered Medical Home

Patient-Centered Outcomes Research Institute

Primary Care Provider or Primary Care Physician

Physician Consortium for Performance Improvement (ceased operations 7/31/2020)

paper Clinical Quality Measure or paper Quality Measure

Proportion of Days Covered

Prescription Drug Monitoring Program

Personal Emergency Response System

Medicare's Physician Fee Schedule

Doctor of Pharmacy is a professional doctorate in pharmacy. In some countries, it is a first professional degree and a prerequisite for licensing to practice the profession of pharmacy or to become a clinical pharmacist. See related articles and RPh for comparisons between PharmD and RPh.

Public Health Emergency

Personal Health Information (sometimes referred to as Protected Health Information) – Information that is considered private and protected by HIPAA and other regulations

Personal Health Records contain the same types of information as EHRs—diagnoses, medications, immunizations, family medical histories, and provider contact information—but are designed to be set up, accessed, and managed by patients. Patients can use PHRs to maintain and manage their health(...)

Per Member Per Month (payment)

Per Member Per Year (payment)

Patients Over Paperwork

Pharmacy Quality Alliance

Physician Quality Rating System

Patient-Reported Outcome Measures

Primary Source Validation

A Qualified Clinical Data Registry is a Centers for Medicare & Medicaid Services (CMS) approved vendor that is in the business of improving health care quality. These organizations may include specialty societies, regional health collaboratives, large health systems or software vendors(...)

Quality Data Element

Quality Data Model

Quality Data Model + Clinical Quality Language

Qualified Health Information Network

Quality Improvement Activity

Quality Improvement and Evaluation System

Quality Improvement Indicator

Quality Payment Program. Provides tools and resources to help clinicians give patients the best possible care. Clinicians can choose how to participate based on your practice size, specialty, location, or patient population. There are 2 ways clinicians can choose to participate in the(...)

Quality Reporting Document Architecture. A QRDA report is a quality data report. Each report contains calculated summary data for one or more measures for a specified population of patients within a particular health system over a specific period of time. It is used as a transport(...)

Quality Reporting Program

Quality Rating System. Section 1311(c)(3) of the Affordable Care Act directs the HHS Secretary to develop a system that rates QHPs based on relative quality and price. It also requires Marketplaces to display QHP quality ratings on Marketplace websites to assist in consumer selection of QHPs.(...)

The QHIN Technical Framework (QTF): This document is incorporated by reference in the Common Agreement. It details the technical and functional components for exchange among QHINs.

QIES Technical Support Office is a website that provides technical guidance such as references & manuals, software tools and training materials for providers, and vendors as well as state agency, regional office personnel and other organizations performing Survey & Certification functions.

The QUICK data model provides a logical view of clinical data from the perspective of representing quality measurement and decision support knowledge.

Risk Adjustment Data Validation – Formal name for the CMS audits of MA plans which verifies clinical documentation supporting the HCC codes submitted by the payer underlying the capitated payments for members by CMS.

Risk Adjustment Factor – A numeric value used as a determinant for the actual financial reimbursement in a capitated risk model.

Renin Angiotensin System Antagonist

Recognized Coordinating Entity: the Recognized Coordinating Entity (RCE) supporting TEFCA implementation. Under the cooperative agreement, the RCE is responsible for developing, updating, implementing, and maintaining the Common Agreement and the Qualified Health Information Network Technical(...)

Rural Emergency Hospitals. Defined by CAA as a facility that is enrolled in the Medicare program on or after January 1, 2023, does not provide any acute care inpatient services, has a transfer agreement in effect with level I or level II trauma center, meets certain staff licensure, staffing(...)

Rare and Expensive Care Management Program

REpresentational State Transfer is a software architectural style that defines a set of constraints to be used for creating Web services. Web services that conform to the REST architectural style, called RESTful Web services, provide interoperability between computer systems on the internet.(...)

Radio Frequency IDentification

Regional Health Information Organization

Reference Information Model.

Registered Nurse

Return on Investment – Traditional definition of a financial return on a given investment, typically as a percentage of the estimated or actual investment amount.

Release of Information – The request for health records by various parties who have explicitly or implicit authorization to do so (payer, life insurance underwriter, consumer)

Registered Pharmacist is a professional degree that is required before a person can become a practicing pharmacist. See related articles and PharmD for comparisons between RPh and PharmD.

Remote Patient Monitoring

Real Time Benefit Tool

Real-Time Location System

Robert Wood Johnson Foundation

The Substance Abuse and Mental Health Services Administration is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation.

State Innovation Model

Skilled Nursing Facility

Systematized Nomenclature of Medicine Clinical Terms

Skilled Nursing Unit

Structured Query Language. An international standard for database manipulation.

Standard for Trial Use

Statin Use in Persons with Diabetes

Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT for Patients and Communities Act

The Total Cost of Care waiver approved by CMS for the state of Maryland allows the state to waive federal Medicare rules in favor of state-regulated payment to hospitals.

Trusted Exchange Framework: A common set of principles that are designed to facilitate trust between HINs and by which all HINs should abide in order to enable widespread data exchange. These principles are the foundational concepts that guide the development of the Common Agreement.

Trusted Exchange Framework and Common Agreement

Technical Expert Panel

The Joint Commission (old school JCAHO)

Timed Up and Go Test. A test typically for elderly patients to assess mobility.

Uniform Billing form 92

Uniform Data System

User Language

Unified Landing Page

Utilization Management

Unified Modeling Language

Universal Provider Identification Number or Unique Physician Identification Number

Utilization Review Accreditation Commission (commonly referred to as “yo͞o-rak”)

User Requirements

United States Core Data for Interoperability is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.

Universally Unique IDentifier is a 128-bit number used to identify information in computer systems. The term globally unique identifier (GUID) is also used. When generated according to the standard methods, UUIDs are, for practical purposes, unique. Their uniqueness does not depend on a(...)

Value Based Care

Value-Based Modifier. The Value-Based Modifier provided for differential payment under the Medicare Physician Fee Schedule (PFS) is based on the quality of care furnished to Medicare beneficiaries compared to the cost of care during a performance period. The Value-Based Modifier was an(...)

Value Based Payment

Value Set Authority Center. The VSAC is a repository and authoring tool for public value sets created by external programs. Value sets are lists of codes and corresponding terms, from NLM-hosted standard clinical vocabularies (such as SNOMED CT®, RxNorm, LOINC® and others), that define(...)

Workgroup for Electronic Data Interchange

World Health Organization

World Wide Web - "The Internet"

See ASC X12.

Extensible Markup Language

Year of Birth

Year to Date

Zone Program Integrity Contractor is an entity established in the United States by the Centers for Medicare & Medicaid Services (CMS) to combat fraud, waste, and abuse in the Medicare program. As a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which(...)

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. The purpose of these(...)