| A | B |
|---|
| ABSENT SICK MOVED TO MTF | Patients who have been moved from a non-U.S. military facility to a MTF. |
| ACCOUNT CODE, MEDICAL EXPENSE AND PERFORMANCE REPORTING SYSTEM | Accounts established that provide a title of and a description for each of the functions and activities performed in a Military Treatment Facility (MTF). The account codes will be treated as accounting entities and used in the step-down process. The step-down process is established by DoD 6010.13-M (reference (a)). All MEPRS account codes will not be considered a work center, but all work centers will be a MEPRS account code. (See definition of work center.) |
| ACCREDITATION | Formal process by which an agency or organization evaluates and recognizes an institution or program of study as meeting certain predetermined criteria or standards. |
| ACCREDITED RECORDS TECHNICIAN | An accredited records technician performs technical medical record functions in various health care facilities. These functions include coding diseases and operations, maintaining health record indexes, transcribing medical reports, and controlling the usage and release of health information. |
| ACUTE CARE | A pattern of health care in which the patient is treated for an acute episode of illness for the sequel of an accident of other trauma or during recovery for surgery. It may involve intensive care and is often necessary for only a short period of time. |
| ACUTE CARE SERVICES | Coordinated services related to the examination, diagnosis, care, treatment, and disposition of acute episodes of illnesses. |
| ACUTE DISEASE | Disease characterized by a single episode of fairly short duration, usually less than 30 days, and from which the patient can be expected to return to his or her normal or previous state and level of activity. |
| ADDITIONAL DIAGNOSIS | Any diagnosis, other than the principal diagnosis, that describes a condition for which a patient receives treatment or which the physician considers of sufficient significance to warrant inclusion for investigative medical studies |
| ADJUSTMENT | The process of adding, subtracting, or otherwise modifying MTF incurred expenses into an array or format that reflects the Medical Expense and Performance Reporting System recognized expenses and statistics, as prescribed by DoD 6010.13-M (reference (a)). |
| ADMISSION | The act of placing an individual under treatment or observation in a medical center or hospital. The day of admission is the day on which the medical center or hospital makes a formal acceptance (assignment of a register number) of the patient who is to be provided with room, board, and continuous nursing service in an area of the hospital where patients normally stay at least overnight. When reporting admission data always exclude: total absent-sick patients, carded-for-record only (CRO) cases, and transient patients. Admission data can be reported in three ways: |
| ADMITTING DIAGNOSIS | The immediate condition that caused the patient's admission to the MTF for the current, uninterrupted period of hospitalization. |
| AMBULATORY CARE | The examination, diagnosis, treatment and proper disposition of all categories of eligible inpatients and outpatients presenting themselves to the various ambulatory care specialty and/or subspecialty clinics. |
| AMBULATORY CARE CLINIC | An entity or unit of a medical or dental treatment facility that is organized and staffed to provide medical treatment in a particular specialty and/or subspecialty; and holds regular hours in a designated place. |
| AMERICAN MANAGED CARE AND REVIEW ASSOCIATION | A trade association representing managed care indemnity plans, PPOs, MCOs, and HMOs. Tends to focus on issues important to open panel types of plans. |
| AMOUNT ALLOWED | The amount on a claim which has been allowed by the FI/Contractor for services and supplies as justifiably reasonable. These allowable amounts may vary depending on area of the country and will also vary depending upon whether or not the provider is an authorized CHAMPUS provider. A claim will have a Total Amount Allowed for the total of items on the claim, and also an individual breakdown of the Amount Allowed per Service, etc. |
| ANCILLARY | Tests and procedures ordered by healthcare providers to assist in patient diagnosis or treatment (radiology, laboratory, pathology, etc.). |
| ANCILLARY SERVICES | Those services that participate in the care of patients principally by assisting and augmenting the talents of attending health care providers in diagnosing and treating human ills. Ancillary services generally do not have primary responsibility for the clinical management of patients. |
| ANTITRUST LAWS | A group of statutes that outline fair trade practices in a competitive marketplace. The chief enforcer of these laws is the Federal Trade Commission (FTC). The FTC is a five-person administrative agency that conducts investigations, announces rules and regulations and enforces statutory provisions prohibiting unfair trade and competitive practices (especially in the instances of collaboration, merger or acquisition. As many health systems move toward collaboration, combinations and closer relations, the presence of antitrust liability will have a definite impact on the future of health care delivery. |
| AT RISK PROVIDER | Either the MTF or the Government-selected contractor is a provider at risk for benefit dollars by taking the full financial risk on a prospective basis for the provision of all TRICARE covered health benefits. |
| ATTENDING PHYSICIAN | The physician with defined clinical privileges who has the primary responsibility for diagnosis and treatment of the patient. A physician with privileges to practice the specialty independently. The physician may have either primary or consulting responsibilities depending on the case. There will always be only one primary physician; however, under very extraordinary circumstances, because of the presence of complex, serious and multiple, but related, medical conditions, a patient may have more than one attending physician providing treatment at the same time. |
