| H |
| HCFA
1500 |
Top |
The
Health Care Finance Administration's standard
form for submitting physician service claims to
third party (insurance) companies. |
| Health
Care Financing Administration (HCFA) |
Top |
The
agency within the Department of Health and Human
Services which administers federal health
financing and related regulatory programs,
principally the Medicare, Medicaid, and Peer
Review Organization. |
| Health
Maintenance Organization (HMO) |
Top |
A
legal corporation that offers health insurance
and medical care. HMOs typically offer a range
of health care services at a fixed price (see
capitation). Types of HMOs:
- Staff Model --
Organization owns its clinics and employs
its docs.
- Group Model --
Contract with medical groups for services.
- IPA Model --
Contract with an IPA that in turn contracts
with individual physicians.
- Direct
Contract Model -- Contracts directly with
individual physicians.
- Mixed Model --
Members get options ranging from staff to
IPA models.
|
| Health
Plan |
Top |
A
generic term to refer to a specific benefit
package offered by an insurer. Also used to
pertain to the insurer; e.g., "I signed up
for the Blue Cross health plan." |
| Health
Plan Employer Data and Information Set (HEDIS) |
Top |
A
set of performance measures designed to
standardize the way health plans report data to
employers. HEDIS currently measures five major
areas of health plan performance: quality,
access and patient satisfaction, membership and
utilization, finance, and descriptive
information on health plan management. |
| HHS |
Top |
The
Department of Health and Human Services that is
responsible for health-related programs and
issues. Formerly HEW, the Department of Health,
Education, and Welfare. The Office of Health
Maintenance Organizations (OHMO) is part of HHS
and detailed information on most companies is
available here through the Freedom of
Information Act. |
| Hold
Harmless Clause |
Top |
A
clause frequently found in managed care
contracts whereby the HMO and the physician hold
each other not liable for malpractice or
corporate malfeasance if either of the parties
is found to be liable. Many insurance carriers
exclude this type of liability from coverage. It
may also refer to language that prohibits the
provider from billing patients if their managed
care company becomes insolvent. State and
federal regulations may require this language. |
| Home
Health Care |
Top |
Full
range of medical and other health related
services such as physical therapy, nursing,
counseling, and social services that are
delivered in the home of a patient, by a
provider. |
| Hospice
Services |
Top |
Services
to provide care to the terminally ill and their
families. |
| Hospital |
Top |
Any
institution duly licensed, certified, and
operated as a Hospital. In no event shall the
term "Hospital" include a convalescent
facility, nursing home, or any institution or
part thereof which is used principally as a
convalescence facility, rest facility, nursing
facility, or facility for the aged. |
| Hospital
Affiliation |
Top |
A
contractual agreement between an HMO and one or
more hospitals whereby the hospital provides the
inpatient benefits offered by the HMO. |
| Hospital
Audit Companies |
Top |
Retrospective
audit providers that typically achieve a 15-20
percent savings of billed claims. |
| Hospital
Day |
Top |
A
term to describe any twenty-four hour period
commencing at 12:00 a.m., or 12:00 p.m.,
whichever is used by a hospital to determine a
hospital day, during which a patient receives
hospital services at the hospital. |
| Hospital
Days (per 1,000) |
Top |
Measurements
of the number of days of hospital care HMO
members use in a year. It is calculated as
follows: Total Number of Days Spent In A
Hospital by Members divided by Total Members.
This information is available through HHS, OHMO
and a variety of sources. |
