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HCFA 1500 - The Health Care Finance Administration's standard form for submitting provider service claims to third party companies or insurance carrier. HCFA is now called CMS.

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HCFA (CMS) - Now called CMS, CMS is the centralized government agency within the Department of Health and Human Services which directs and oversees the Medicare and Medicaid programs and conducts study to support those programs. It usually oversees the state's administrations of Medicaid, while directly administering Medicare.

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Health - The state of total physical, mental, and social well-being and not merely the absence of disease or infirmity. It is documented; however, that health has many dimensions and is largely culturally defined. The relative importance of variety of disabilities will differ depending upon the cultural milieu and the role of the affected individual in that culture.

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Health and Human Services (HHS) - The Department of Health and Human Services that is answerable for health-related programs and issues. Previously HEW, the Department of Health, Education, and Welfare. The Office of Health Maintenance Organizations (OHMO) is part of HHS and complete information on most companies is available here through the Freedom of Information Act.

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Health Benefits Package - The services and products which a health plan offers.

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Health Care, Healthcare - Care, services, and supplies associated to the health of an individual. Health care includes preventive, diagnostic, therapeutic, rehabilitative, maintenance, or analgesic care, and counseling, among other services. Healthcare also includes the sale and provision of prescription drugs or devices.

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Health Care Clearinghouse - A public or private entity that does each of the following 1) Processes or facilitates the processing of information established from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction; 2) Receives a standard transaction from one more entity and processes or facilitates the processing of information into nonstandard format or nonstandard data content for a receiving entity.

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Health Care Operations - Institutional actions that are necessary to maintain and monitor the operations of the institution. Examples include but are not limited to: conducting excellence assessment and improvement activities; developing clinical guidelines; case management; reviewing the capability or qualifications of health care professionals; education and training of students, trainees and practitioners; fraud and abuse programs; business planning and management; and client service.

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Health Care Provider - Providers of medical or health care or researchers who offer health care are health care providers. Normally health care providers are clinics, hospitals, doctors, dentists, psychologists and parallel professionals.

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Healthcare Provider Taxonomy Codes - An administrative code set that classify health care providers by type and area of specialization. The code set will be used in convinced adopted transactions.

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Healthcare Quality According to the institution of Medicine, "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"

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Health Care Quality Improvement Act (HCQIA) - A federal act which exempts hospitals, group practices, and HMOs from positive antitrust provisions as they apply to credentialing and examine review so long as these entities stick to due process standards.

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Health Care Quality Improvement Program (HCQIP) - A program initiated by the CMS to progress the quality of care delivered to Medicare enrollees in managed care plans.

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Health Employer Data and Information Set (HEDIS) - A set of HMO presentation measures that are maintained by the National Committee for Quality Assurance. HEDIS data is composed annually and provides an informational resource for the public on issues of health plan quality.

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Health Information - Information in any form that relates to the past, present or future physical or mental health of an individual. That information could be produced or received by a health care provider, a health plan, a public health authority, an employer, a life insurer, a school, a university or a health care clearinghouse. All health information is protected by state and federal secrecy laws and by HIPAA privacy rules

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Health Information Network (HIN) - A computer network that provides access to a catalog of medical information.

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Health Insurance - Financial protection adjacent to the health care costs of the insured person. May be obtained in a collection or individual policy.

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Health Insurance Portability and Accountability Act of 1996 (HIPAA) - A Federal law that allows persons to be eligible immediately for comparable health insurance coverage when they change their employment relationships. This legislation sets a model for Federal involvement in insurance regulation. It sets minimum standards for rule of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance.

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Health Insurance Purchasing Cooperatives (HIPC) - Public or private organizations that safe health insurance coverage for the workers of all member employers. The goal of these organizations is to merge purchasing responsibilities to obtain greater bargaining clout with health insurers, plans and providers, to decrease the administrative costs of buying, selling and managing insurance policies.

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Health Insuring Organization (HIO) - An organization that contracts with a state Medicaid agency as an economic intermediary.

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Health Level Seven (HL7) - A data interchange protocol for health care computer applications that simplify the ability of different vendor-supplied IS systems to interconnect. Although not a software program in itself, HL7 requires that each healthcare software seller program HL7 interfaces for its products.

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Health Maintenance Organization (HMO) - A person that provides offers or arranges for coverage of designated health services needed by members for a fixed, prepaid premium. HMOs offer prepaid, complete health coverage for both hospital and physician services. The HMO is remunerated monthly premiums or capitates rates by the payers, which include employers, insurance companies, government agencies, and other groups representing covered lives. The HMO must convene the specifications of the federal HMO act as well as meeting many rules and regulations required at the state level.

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Health Manpower Shortage Area (HMSA) - An area or set that the U.S. Department of Health and Human Services designates as having an inadequate supply of health care providers. HMSAs can include: (1) an urban or rural geographic area, (2) a population group for which access barrier can be demonstrated to prevent members of the group from using local providers, or (3) medium and maximum-security correctional institution and public or non-profit private residential facilities.

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Health of Seniors Survey - A CMS survey that measures Medicare patient's functional position.

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Health Oversight Agency - Under HIPAA rules, this refers to a person or entity at any stage of the federal, state, local or tribal government that oversees the health care system or requires health information to decide eligibility or compliance or to enforce civil rights laws.

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Health Plan - An entity that assumes the risk of paying for medical treatments, for example uninsured patient, self-insured employer, payer, or HMO.

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Health Plan Employer Data and Information Set (HEDIS) - A set of performance measures intended to standardize the way health plans report data to employers. HEDIS currently measures five major areas of health plan performance such as quality, access and patient satisfaction, membership and utilization, finance, and descriptive information on health plan management.

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Health Plan Management System (HPMS) - A database of information on Medicare Part A and Part B recipients who are enrolled in synchronized care plans.

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Health Professional Shortage Area (HPSA) - A geographic area, population group, or medical ability that HHS determines to be served by too few health professionals of particular specialties. Physicians who give services in HPSAs qualify for the Medicare bonus payments. This may also comprise re-payment of medical school loans or other incentives.

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Health Promotion Programs - Preventive care programs designed to educate and inspire members to prevent illness and injury and to promote good health through lifestyle choices, such as smoking cessation and dietetic changes.

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Health Resources and Services Administration (HRSA) - HRSA is an element of the U.S. Department of Health and Human Services. Included in HRSA tasks is administration of the Ryan White Care funds with a budget of about $1 billion/year to support a continuum of care services for persons with HIV infection.

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Health Service Agreement (HSA) - Detailed justification of procedures and benefits provided to an employer by a health plan.

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Health Status - The state of health of a particular individual, group, or population. It may be calculated by obtaining proxies such as people's subjective assessments of their health by one or more indicators of mortality and morbidity in the population, such as longevity or maternal and infant mortality or by using the incidence or prevalence of major diseases.

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Health Risk Appraisal or Health Risk Assessment (HRA) - A process by which an MCO uses information about a plan member's health status, personal and family health history, and health-related behaviors to predict the member's possibility of experiencing specific illnesses or injuries.

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Hold Harmless Clause or Hold Harmless Provision - A contract section which forbids providers from seeking compensation from patients if the health plan fails to reimburse the providers because of insolvency or for any other reason. Many insurance carriers prohibit this type of liability from coverage.

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Home Health Care - Full range of medical and other health associated services such as physical therapy, nursing, counseling, and social services that are delivered in the home of a patient, by a provider.

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Horizontal integration, Horizontal Consolidation - Integration of two or more firms at the same level of production in some formal, legal relationship. In hospital networks, this may submit to the grouping of several hospitals, the grouping of outpatient clinics with the hospital or a geographic network of various health care services. Integrated systems search for integration of both vertically with some organizations and horizontally with others.

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Hospice or Hospice Care - Facility or program provided that care for the terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional and religious needs of the patient. Hospice also provides sustain to the patient's family or caregiver as well.

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Hospital - Any institution suitably licensed, certified, and operated as a Hospital. In no occasion shall the term "Hospital" include a convalescent facility, nursing home, or any institution or part thereof which is used mainly as a convalescence facility, rest facility, nursing facility, or facility for the aged.

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Hospital-Acquired Infection (HAI) - Hospital-acquired infections include almost all clinically evident infections that do not create from patient's original admitting diagnosis. Within hours after admission, a patient's flora begins to obtain characteristics of the surrounding bacterial pool. Most infections that become clinically manifest after 48 hours of hospitalization are considered hospital-acquired.

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Hospital Affiliation - A contractual conformity between a health plan and one or more hospitals whereby the hospital provides the inpatient services offered by the health plan.

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Hospital Alliances - Groups of hospitals joined together to share services and develops group-purchasing programs to reduce costs. May also refer to a spectrum of contracts, agreements or handshake arrangements for hospitals to work jointly in developing programs, serving covered lives or contracting with payers or health plans.

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Hospital Audit Companies - Presentation of audit providers that typically achieve a 15-20 percent savings of billed claims.

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Hospital Days - A dimension of the number of days of hospital care health plan enrollees use in a year. It is calculated as follows: Total Number of Days Spent in a Hospital by Members separated by Total Members. This information is available through HHS, OHMO and a range of state sources.

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Hospitalists - Physicians who spend a considerable amount of their time in a hospital setting where they accept admissions to their inpatient services from local primary care providers. In most belongings, hospitalists are employees of the hospital.

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Human Subject - Under HIPAA rules, this term refers to a living topic participating in research about whom directly or indirectly identifiable health information or data are obtained or created.

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