Home Page |  About Us  |  FAQ's  |  Providers  | Applications  | California Birth Profiles  Contact Us 

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) - The Federal law that formed the present risk and cost contract provisions below which health plans contract with CMS. Legislation that created the target rate of raise cost based limits on reimbursements for inpatient operating costs. These limits are measured per Medicare discharges total amounts. A facility's target amount is resulting from costs in its base year updated to the current financial year by the annual allowable rate of increase.

Back to top

Tertiary Care - Services provided by highly particular providers such as neurosurgeons, thoracic surgeons and intensive care units. These services often need for highly sophisticated technology and facilities.

Back to top

Therapeutic Alternatives - Drug products that provide the similar pharmacological or chemical result in equivalent doses.

Back to top

Therapeutic Substitution - The dispensing of a different chemical unit within the same drug class of a drug scheduled on a pharmacy benefit management plan's formulary. Therapeutic substitution always requires physician support.

Back to top

Third Party Administrator (TPA) - A self-governing organization that provides administrative services including claims dispensation and underwriting for other entities, such as insurance companies or employers. Frequently insurance companies will contract as TPAs with other insurance companies or health plans.

Back to top

Third-Party Payment - Payment by a fiscal agent such as an HMO, insurance company or government relatively than direct payment by the patient for medical care services. The payment for health care when the beneficiary is not making payment, in entire or in part, in his own behalf.

Back to top

Third-Party Payer - Any organization, public or private that pays or insures health or medical operating expense on behalf of beneficiaries or recipients. An individual pays a premium for such coverage in all personal and in some public programs the payer organization then pays bills on the individual's behalf.

Back to top

Three-Tier Copayment Structure - A pharmacy benefit copayment system below which a member is essential to pay one copayment amount for a generic drug. And a higher copay-ment amount for a brand-name drug incorporated on the health plan's formulary, and an even higher copayment amount for a nonformulary drug.

Back to top

Tiered Formulary - List of favored prescription drugs in which different drugs have dissimilar co-pays, according to the policies of Drug Plans or Prescription Drug Benefits. Each drug is assign to a specific 'tier' within the formulary. The most cost-effective drugs, often generic drugs, belong to the most chosen tier and characteristically have the lowest co-pay, whereas the least cost efficient drugs belong to the least preferred tier and have the highest co-pay.

Back to top

Tort Reform - Legislative limits or changes or judicial improvement of the rules governing medical misconduct lawsuits and other lawsuits. Reform implies that limits can be located on individual rights to sue or on the amounts or situations for which they can seek relief. Tort is measured to be by some as the primary cause of the rising costs of health care. Reform, then, would lesser health care costs.

Back to top

Total Margin - A measure that compares total hospital income and expenses for inpatient, outpatient, and non-patient care activities. The total margin is intended by subtracting total expenses from total revenue and separating by total revenue.

Back to top

Total Quality Management (TQM) - Related to quality management, TQM identifies necessary system elements to measure, design, and choose processes that consistently bring superior outcomes. These fundamentals build up the basis for TQM.

Back to top

Tracking of Disclosures - The HIPAA Privacy Rule gives individuals the right to demand an accounting of disclosures of confined health information over the previous six years. If an individual authorizes uses or disclosures for research, the disclosures do not need to be track, but disclosures must be tracked if the researcher receives an IRB-approved waiver of approval.

Back to top

Transaction- Usually refers to the replace of information for administrative or financial purposes such as health insurance claims or payment. Under HIPAA, this is the exchange of information between two parties to take out financial or administrative activities associated to health care.

Back to top

Transfer- Movement of a patient between hospitals or between units in a known hospital. In Medicare, a full DRG rate is paid only to transfer patients that are defined as discharged. In managed care, transfers are often recommended by UR entities to move patients to lower cost care facilities.

Back to top

Treatment- The provision of health care by one or more health care providers. Treatment includes any discussion, referral or other exchanges of information to manage a patient's care. The HIPAA Privacy Notice explains that the HIPAA Privacy Rule allows Partners and it is affiliated to use and disclose protected health information for treatment purposes without exact authorization.

Back to top

Trending- Methods of estimating future costs of health services by reviewing past trends in cost and use of these services.

Back to top

Triage- Triage is the acts of categorizing patients according to acuity and by determining that need services first. Most normally occurs in emergency rooms, but, can occur in any healthcare setting. Classification of ill or injured persons by sternness of condition. Designed to exploit and create the most efficient use of scarce resources of medical personnel and facilities.

Back to top

Triage Providers - Medical personnel who categorize ill or injured persons by severity of condition. When providers or insurance companies direct triage on the telephone, this service may be referred to as pre-authorization center, crisis center, and call center or information line. Providers may also direct triage in emergency rooms, walk-in centers, disaster scenes or outreach centers.

Back to top

Triple Option Plan - A plan that gives subscribers or employees choices among HMO, PPO and traditional indemnity plans.

Back to top