Payment made to an ambulatory surgery center (ASC) for facility-related costs. A fixed payment rate for procedures designated to be ASC procedures. ASC procedures are classified into nine payment groups. A fixed payment rate is designated for each group. The ASC facility payment in each group is a single rate adjusted for geographic variation. This prospectively determined rate covers the cost of standard overhead items (nursing care, supplies, equipment, and use of facility). It does not include physicians' fees and some other medical items and services (such as prostheses)

American Association of Retired Persons

Amount provider actually bills a patient, which may differ from the allowable charge.

The monitoring of the distribution of kinds of patients admitted to a hospital (that is, of the admission case mix) in order to detect changing needs for services, displacement of patients to other institutions, or other changes.

A term sometimes applied to procedures which an emergency medical technician-paramedic may perform, but which lower levels of EMT’s may not perform.  Such procedures may include, for example, insertion of a tube in the patient’s airway for assistance in breathing, and administration of certain drugs.

A situation in which patients with greater than average need for medical and hospital care enroll in a prepaid health plan in greater numbers than they occur in a cross-section of the population.  A plan that somehow encouraged or allowed people to sign up when they were already ill would suffer from adverse selection.

Coalition model composed of important community groups that extends a farther reach into the community and which can be useful in providing current information about the community to coalition leaders.

A service that includes services and enables the alcoholic patient to return to normal functioning.  It is contrasted with alcoholism treatment, which confines itself to the acute episode of intoxication.

A person who is not a physician, nurse, or pharmacist, and who works in the health field.  An allied health professional may, for example, be a dietitian, an emergency medical technician, or an aide.

Average or maximum amount the third party payor will reimburse providers for the service.

Medical services, that may include diagnosis, treatment, and rehabilitation, that are provided on an outpatient (nonhospitalized) basis.

A system by which hospital outpatient procedures are classified into groups of services that are similar clinically and require similar amounts of resources. A payment rate is established for each APC, which is paid by Medicare under the Outpatient Prospective Payment System (OPPS). Depending on the services provided, hospitals may be paid for more than one APC for an encounter.

A surgical procedure, for which a patient is admitted, treated and discharged the same day; also referred to as outpatient surgery.

Ambulatory Surgery Centers (ASC) are either hospital-based or freestanding entities which operate exclusively for the purpose of furnishing outpatient surgical procedures.

American Managed Care Pharmacy

The previous name of the American College of Physician Executives (ACPE).  The ACPE is a national medical specialty society whose members are physicians with leadership, management, or administrative responsibilities.

AARP

A qualified doctor who administers an anesthetic (anesthesia) to a patient before the patient receives any type of treatment

A medical specialty concerned with purposeful depression of nerve function, characterized by loss of feeling or sensation, usually the result of pharmacologic action by anesthetics, and induced to allow performance of surgery or other painful procedures. This specialty is also concerned with treating pain associated with diseases/conditions.

The drug or other agent that depresses feeling or the sensation or pain.

Ambulatory Payment Classification

A system by which hospital outpatient procedures are classified into groups of services that are similar clinically and require similar amounts of resources. A payment rate is established for each APC, which is paid by Medicare under the Outpatient Prospective Payment System (OPPS). Depending on the services provided, hospitals may be paid for more than one APC for an encounter.

Ambulatory Surgery Center
Ambulatory Surgery Centers (ASC) are either hospital-based or freestanding entities which operate exclusively for the purpose of furnishing outpatient surgical procedures.

Average Sales Price (ASP) —The average sales price as determined using the methodology applied under paragraph (3) of Sec. 1847A. [42 U.S.C. 1395w–3a] (a) Application for single source drugs and biologicals furnished before April 1, 2008, and using the methodology applied under paragraph (6) for single source drugs and biologicals furnished on or after April 1, 2008, for all National Drug Codes assigned to such drug or biological product.

Biologically based disorder that includes a combination of systems such as inattentiveness or distractibility, impulsivity, and, in some individuals, physical restlessness or hyperactive behavior.  Also known as Attention Deficit Hyperactivity Disorder (ADHD).

As it applies to managed care, authorization is the approval of care, such as hospitalization which is necessary for coverage and payment. Preauthorization may be required before admission takes place or before care is given by non-HMO providers.