| A | B |
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| ABSENT SICK | An Active Duty (Army, Navy, Air Force, and Marine Corps) member hospitalized in other than an U.S. Military Treatment Facility and for whom administrative responsibility has been assigned to an U.S. Military Treatment Facility (MTF). |
| ABSENT SICK MOVED TO MTF | Patients who have been moved from a non-U.S. military facility to a MTF. |
| TOTAL ABSENT SICK | Patients who are absent sick the total time (never moved 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.) |
| ACCOUNTING ENTITY | A subdivision of an agency (an organization) for which a separate, complete system of accounts is maintained. The system of accounts will include the balances of appropriations (fund resources), and such balances, not part of appropriation balances, for which the accounting entity is administratively held accountable (assets and liabilities). Asset and liability balances imply determining the results of operations and the operating expense accounts. |
| 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. |
| ACCRUAL BASIS OF ACCOUNTING | A system of accounting which consists of recognizing in the books and records of the accounting entity the significant and accountable aspects of financial transactions or events as they occur. That is, to recognize revenues when earned and expenses when incurred. For a more detailed discussion of this accounting practice, see DoD 6010.13-M (reference (a)). |
| ACTIVE DUTY | Full-time duty in the active military service of the United States. It includes federal duty of the active list (for National Guard personnel), full-time training duty, annual training, and attendance while in the active military service at a school designated as a service school by law or the Secretary of the Military Department concerned. As it relates to medical care, the term Active Duty does not include Active Duty for Training. |
| ACTIVE DUTY FOR TRAINING | A tour of active duty that is used for training members of the Reserve components to provide trained units and qualified persons to fill the needs of the Armed Forces in time of war or national emergency and such other times as the national security requires. The tour of duty is under orders, which provide for return to non-active status when the period of active duty for training is completed. It includes annual training, special tours of active duty for training, school tours, and the initial tour performed by non-prior service enlistees. |
| ACTIVE DUTY MEMBER | A person appointed, enlisted, inducted, or called, ordered, or conscripted into a military service. Active duty members include members of the National Guard or Reserve who are ordered to active duty or active duty for training. |
| 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 |
| ADDITIONAL SPECIAL PAY (ASP) | Medical and dental officers, not undergoing internship or initial residency training, and who execute a written agreement to remain on active duty for a period of not less than one year, are entitled to receive an annual ASP bonus at the rates prescribed by 37 U.S.C. (reference (b)). ASP is intended to provide an incentive for all medical and dental officers to remain on active duty, regardless of specialty. Certain Reservists may be eligible under Section 302f of reference (b). |
| ADDITIVE (MANPOWER). | Work done that is not part of the basic work center description and therefore not part of the basic work center manpower standard. |
| ADJUSTED AVERAGE PER CAPITA COST | Used by the Health Care Financing Administration (HCFA) as the calculation for the funds required to care for Medicare recipients; calculated by county for a 5-year moving average and based on 95% of "fee-for-service" Medicare costs for that county; the standard monthly payment to a federally qualified Medicare HMO contractor containing 122 actuarial stratifications for age, sex, Medicaid eligibility, institutional status, end-stage renal disease (ESRD), and the patient's eligibility for Part A and Part B of Medicare. (Reference DoD Medicare demonstration, pending the outcome of negotiations or legislation). |
| 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: |
| ADMISSION-LIVE BIRTH | The admission of a live birth in a MTF. The admission of a live birth is deemed to occur at the time of birth. |
| ADMISSION-EXCLUDING LIVE BIRTH | Admissions minus Admission-Live Birth. |
| ADMISSION-TOTAL | All admissions excluding the three exclusions cited in P1.1.18 above. |
| ADMISSION AND DISPOSITION REPORT | A daily hospital report reflecting patients gained and lost, changes in status, the numerical strengths of transient patients and boarders, and other transactions such as CRO cases, interward transfers, and passes. |
| ADMITTING DIAGNOSIS | The immediate condition that caused the patient's admission to the MTF for the current, uninterrupted period of hospitalization. |
| AEROMEDICAL EVACUATION | The movement of patients under medical supervision to and between Military Treatment Facilities by military or military chartered air transportation. See also: transient patient. |
| AEROMEDICAL EVACUATION CONTROL CENTER | The control facility established by the commander of an air transport division, air force or air command. It operates in conjunction with the command movement control center and coordinates overall medical requirements with airlift capability. It also assigns medical missions to the appropriate aeromedical evacuation elements in the system and monitors patient movement activities. |
| AEROMEDICAL EVACUATION CONTROL OFFICER | An officer of the air transport force air command controlling the flow of patients by air. |
| AEROMEDICAL EVACUATION COORDINATING OFFICER | An officer of an originating, intransit, or destination medical facility and/or establishment who coordinates aeromedical evacuation activities of the facility and/or establishment. |
| AEROMEDICAL EVACUATION OPERATIONS OFFICER | An officer of the 10 force or command who is responsible for activities relating to planning and directing aeromedical evacuation operations, maintaining liaison with medical airlift activities concerned, operating an Aeromedical Evacuation Control Center, and otherwise coordinating aircraft and patient movements. |
| AEROMEDICAL EVACUATION SYSTEM | A system that provides control of patient movement by air transport, specialized medical attendants and equipment for inflight medical care, facilities on or in the vicinity of air strips and air bases, for the limited medical care of intransit patients entering, en route via, or leaving the system, and communication with originating, destination, and enroute medical facilities concerning patient transportation. |
| AEROMEDICAL EVACUATION UNIT | An operational medical organization concerned primarily with the management and control of patients being transported via an aeromedical evacuation system or system level. |
| AEROMEDICAL STAGING FACILITY | A medical facility that has aeromedical staging beds, located on or in the vicinity of an emplaning or deplaning air base or air strip that provides reception, administration, processing, ground transportation, feeding and limited medical care for patients entering or leaving an aeromedical evacuation system. Transient patient workload reported as the number of patients processed by staging facilities. |
| AIR TRANSPORTABLE UNIT | A unit other than airborne whose equipment is adapted for air movement. |
| ALCOHOLISM REHABILITATION CENTER | Facility with an organized professional and trained staff that provides treatment and rehabilitative services to patients, and to their families, with a primary diagnosis of alcoholism and/or other substance abuse. |
| ALTERNATIVE DELIVERY SYSTEMS | Health care delivery modes that provide an alternative to traditional fee-for-service by integrating financing issues with patient care services. Anything done outside the inpatient setting or the physician's office based on a payment structure other than an fee-for-service medicine used to be considered "alternative". However, today's rapidly changing health care environment with the growth of HMO's, PPOs and other managed care entities, has made the "alternative" more like the norm. The shape of health care reform also indicates this trend will continue throughout the decade. |
| ALTERNATIVE PRIMARY CARE PRACTITIONER | These non-physician care givers, such as nurse practitioners, midwives, nurses, physician assistants and other extenders, provide primary medical care services at locations varying from rural health clinics to physician offices. The range of primary care services they can deliver is defined by state law, as is the level of physician supervision they require. The current shortage of primary care physicians and the increased emphasis on primary care delivery demands that new ways and means of care provision be examined. |
| 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. |
| AMBULATORY DATA SYSTEM | An interim AIS to validly collect ambulatory encounter data using optimal mark reader technology. |
| AMBULATORY PATIENT VISIT | Refers to immediate (day of procedure), pre-procedure and immediate post-procedure care in an ambulatory setting. Care is required in the facility for less than 24 hours. |
| AMBULATORY PROCEDURE UNIT | Refers to a location or organization within an MTF (or freestanding outpatient clinic). |
| AMBULATORY SURGERY PROGRAM | A facility program for the performance of elective surgical procedures on patients who are admitted and discharged on the day of surgery. |
| AMERICAN ASSOCIATION OF BLOOD BANKS | A civilian blood banking association that sets policies and standards for blood banks within the United States. The AABB also publishes Standards for Blood Banks and Transfusion Services and Technical Manual, both of which have been adopted for peacetime use by the Military Services as official publications. |
| 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. |
| AMOUNT BILLED | The amount billed on a claim for services and supplies is the provider's charge(s) for health care treatment rendered. These amounts will vary depending on the physician, the area of the country, and whether or not the provider is an authorized CHAMPUS provider having pre-agreed to charge certain rates. A claim will have a Total Amount Billed for the total of items on the claim, and also an individual breakdown of the Amount Billed per Service, etc. |
| AMOUNT PAID BY GOVERNMENT AND/OR GOVERNMENT CONTRACTOR | The amount on a claim to be paid by the government and /or government contractor. A professional services claim has only a total amount for amounts to be paid by the government and/or government contractor, so individual breakdowns for each service must be prorated using amounts allowed for the claim. |
| AMOUNT PAID BY OTHER SOURCES | The amount on a claim to be paid by other sources such as other insurance companies. A professional services claim has only a total amount for amounts to be paid by other sources, so individual breakdowns for each service must be prorated using amounts allowed for the claim. |
| AMOUNT PAID BY PATIENT | The amount on a claim that is to be paid by the beneficiary and/or sponsor, after the deduction of all amounts due by other sources (other insurance companies) and amounts to be paid by the government and/or government contractor. The patient paid amount will include patient deductibles due from the claim, patient cost shares, etc. A professional services claim has only a total amount due from the patient, so individual breakdowns for each service must be prorated using amounts allowed for the claim. |
| 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. |
| ANESTHESIA MINUTES OF SERVICE | The elapsed time during any procedure involving an anesthesiologist and/or anesthetist multiplied by the number of anesthesiologists and/or anesthetists, including residents and student nurse anesthetists (when replacing a person trained in anesthesia) participating in the procedure. |
| 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. |
| APPOINTMENT STATUS | Reflects the relationship of the provider to the medical staff. Privileges define the limits of patient care services the provider may render. |
| APPROPRIATE AND NECESSARY HEALTH SERVICES | Services needed to maintain an enrollee in good health including as a minimum, but not limited to, emergency care, inpatient hospital and physician care, outpatient health services and preventive health services delivered by authorized practitioners acting within their scope of practice. |
| AREA JOINT BLOOD PROGRAM OFFICE | A Tri-service staffed office responsible for joint blood product management in an assigned geographic area within a unified command. Each area includes at least one blood transshipment center (BTC) and any number of blood supply units (BSU) and medical treatment elements (MTE). |
| ARMED FORCES INSTITUTE of PATHOLOGY | A tri-Service agency with a mission of consultation and research in the field of pathology for the Department of Defense. |
| ARMED FORCES HEALTH PROFESSIONS SCHOLARSHIP PROGRAM (AFHPSP). | As prescribed under Chapter 105, of 10 U.S.C. (reference (c)), the AFHPSP was established by an Act of Congress in 1972 for the purpose of obtaining adequate numbers of commissioned officers on active duty who are qualified in the various health professions. Under the program, the Department of Defense pays for individuals to attend medical, dental, or some other health professions school, in exchange for a commitment to serve on active duty as a commissioned officer for a prescribed period of time. |
| ARMED FORCES OF THE UNITED STATES | A term used to denote collectively all components of the Army, Navy, Air Force, Marine Corps, and Coast Guard. |
| ARMED SERVICES BLOOD PROGRAM | The combined military blood programs of the individual Services and the Unified Commands in an integrated blood products support system. |
| ARMED SERVICES BLOOD BANK CENTER (ASBBC). | A Tri-Service-service staffed blood bank responsible for the collection and processing of blood products. The ASBBC provides blood products for Military Treatment Facilities of the two or more of the Armed Services. |
| ARMED SERVICES BLOOD PRODUCTS DEPOT | Component staffed; responsible for strategic storage of frozen blood products in a unified command. Frozen blood products are provided to each Command component based on JBPO instructions. |
| ARMED SERVICES BLOOD PROGRAM OFFICE (ASBPO). | A Tri-Service staffed joint health agency responsible for ensuring implementation of blood program policies established by the Assistant Secretary of Defense for Health Affairs. Also, responsible for coordination of the blood programs of the Military Services and Unified Commands to effect standardization of policies, procedures and equipment. Overall DoD manager for blood products (class VIIIB) during military contingencies and when directed by appropriate national command authorities, civilian relief efforts. |
| ARMED SERVICES WHOLE BLOOD PROCESSING LABORATORY (ASWBPL). | A Tri-Service staffed organization responsible for central receipt and re-processing of blood products from CONUS blood banks, and shipment of these products to designated unified command Blood Transshipment Centers (BTC). |
| ASSIGNED | State of belonging to a unit and being counted as part of that unit's assigned strength. |
| ASSIGNMENT FACTOR | The workload ratio used to distribute costs from one work center to two or more other work centers. The assignment factor quantifies the amount of cost reassigned from the intermediate to the final operating expense accounts. See DoD 6010.13-M (reference (a)). |
| ASSIGNMENT OF BENEFITS | The payment of medical benefits directly to a provider of care rather than to a member. Generally requires either a contract between the health plan and the provider, or a written release from the subscriber to the provider allowing the provider to bill the health plan. |
| 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. |
| AUDIT TRAIL VISIT | An audit is a retrospective validation of a patient's episode of care, resulting from a review of the documentation generated by the provider or clinic at the time the care was provided. Audit trail documentation may consist of such things as a log, an appointment schedule, or other lists for selected providers, which lead back to the patient's record. The audit process should include a check of the name of the patient, whether inpatient or outpatient, family member prefix, sponsor's social security number, category of beneficiary, and date of visit, which is then compared to individual patient records to determine if the episode of care was either a valid visit or an occasion of service. |
| AUTHENTICATE | To denote authorship of an entry made in a patient's medical or dental record by means of a written signature, identifiable initials, a computer key, or a personally used rubber stamp; also refers to the process of certifying copies as genuine. |
| AUTHORIZED RECORD OF MEDICAL TREATMENT | Includes the medical record and other medical information that may be maintained on an individual evaluated or treated in a Military Treatment Facility or contract facility. Other medical information includes information from contract clinics maintained by an MTF, specialty clinics, or identifiable by patient and/or provider. |
| AUTOMATED INFORMATION SYSTEM (AIS). | Computer hardware, computer software, telecommunications, information technology, personnel, and other resources that collect, record, process, store, communicate, retrieve, and display information. An AIS can include computer software only, computer hardware only, or a combination of the above (See DoD Directive 8000.1, reference (d).) |
| AUTOMATED SOURCE DATA COLLECTION (ASDC). | Automatic data processing capability provided to high volume ancillary services for collection of detailed data required for step-down of costs to requesting work centers. |
| AVAILABLE HOURS | Those hours for which pay is earned (regular, overtime, and holiday), which are made available by the presence of an assigned employee for the performance of work center functions, or other medical mission needs. |
| AVAILABLE TIME | Those hours worked or expended in support of the health care mission. |
| AVERAGE DAILY CENSUS | Average number of inpatients, excluding newborns, receiving care each day during a reported period. |
| AVERAGE DAILY PATIENT LOAD (ADPL). | The average number of inpatients, including live births, in the hospital receiving care each day during a reported period. It includes patients admitted and discharged on the same day. It excludes patients on convalescent leave and patients authorized to subsisting out. (Formula: ADPL= (Census Bed + Bassinet Days in period)/No. of days in period). |
| AVERAGE DAILY PATIENT LOAD- BASSINET (ADPL-BASS). | The average number of live births assigned to a bassinet and receiving care each day during a reported period. (Formula: ADPL-BASS = Census Bassinet Days in period/No. days in period). |
| AVERAGE DAILY PATIENT LOAD-LIVE BIRTH (ADPL-LB). | The average number of live births receiving care each day during a reported period. This includes bassinet (Nursery) and bed (NICU) days for the live birth. (Formula: ADPL-LB = (Census Bed + Bassinet Days for Live Births in period)/No. days in period). |
| AVERAGE DAILY PATIENT LOAD-EXCLUDING LIVE BIRTHS (ADPL- XLB). | The average number of inpatients, excluding live births, in the hospital receiving care each day during a reported period. It includes patients admitted and discharged on the same day. (Formula: ADPL-XLB = Census Bed Days (excluding live births) in period/No. days in period). |
| AVERAGE DAILY PATIENT LOAD INPATIENT (ADPL-IP). | The average number of inpatients, excluding live births, in the hospital receiving care each day during a reported period. It includes patients on pass or liberty not in excess of 72 hours and patients admitted and discharged on the same day. It excludes days on convalescent leave, and patients authorized to subsist out. Inpatient ADPL is calculated by dividing the number of inpatient bed days during the period by the total number of days in the report period. (Formula: ADPL-IP = No. Inpatient bed days in period / No. days in period) |
| AVERAGE DAILY PATIENT LOAD TOTAL (ADPL-TOT). | The average number of inpatients, including live births remaining after discharge of the mother, in the hospital receiving care each day during a reported period. It includes patients admitted and discharged on the same day. It excludes newborns, patients on convalescent leave, and patients authorized to subsist out. Total ADPL is calculated by dividing the sum of occupied bed days during the period by the total number of days in the report period. (Formula: ADPL-TOT = OBDs in period / No. days in period) |
| AVERAGE LENGTH OF STAY (ALOS). | The average number of days spent in a Military Treatment Facility by an inpatient. It is derived by dividing the total number of discharge bed + bassinet days generated by the dispositions within a period by those dispositions. This computation excludes patients still occupying beds. The SIDR record will be used to compute the ALOS. The ALOS cannot be computed using Medical Expense and Performance Reporting System (MEPRS) data. The formula for: |
| ALOS-BED | =Discharge Bed Days (generated by dispositions) in the period/ No. Dispositions (excludes live birth) in period. |
| ALOS-BASSINET | = (Discharge Bed + Bassinet Days (generated by dispositions) in the period)/No. Dispositions (includes live birth) in period. |
| ALOS-LIVE BIRTH | = (Discharge Bed + Bassinet Days (generated by live birth dispositions) in the period)/No. Live Birth Dispositions in period. |
