Glossary of Terms
This glossary contains many words and acronyms used by the health care team which is often used in conversations with patients.
A request to the insurance company to reverse a decision.
A concentrated volume of fluid or medication given intravenously or through a gastric tube.
Durable power of attorney
A legal document that names someone else (agent) to make health care decisions for you. This is helpful if you become unable to make your own decisions regarding medical treatment wishes.
Do not resuscitate or full resuscitation
Durable Medical Equipment
Do Not Resuscitate. No CPR
Do Not Intubate
Electronic medical record
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list
A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs.
A complaint about the way your Medicare health plan or Medicare drug plan is giving care. For example, you may file a grievance if you have a problem calling the plan or if you're unhappy with the way a staff person at the plan has behaved towards you. However, if you have a complaint about a plan's refusal to cover a service, supply, or prescription, you file an appeal.
Health Information Portability and Accountability Act
An organization that has no connection to the Medicare health plan. Medicare contracts with the IRE to review a case during an appeal.
Doctors, hospitals, pharmacies, and other health care providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. In some insurance plans, your care is only covered if you get it from in-network doctors, hospitals, pharmacies, and other health care providers
Lifetime reserve days
In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.
Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living, like dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living, or in nursing homes. Individuals may need long-term supports and services at any age. Medicare and most health insurance plans don’t pay for long-term care.
Long-term Care Ombudsman
Long-Term Care Ombudsman are advocates for residents of nursing homes, board and care homes, assisted living facilities, and similar adult care facilities. They work to resolve problems of individual residents and to bring about changes at the local, state, and national levels that will improve residents’ care and quality of life. They may be able to provide information about home health agencies in your area.
Long Term Acute Care facility
Licensed Vocational Nurse
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
Medicare Private Fee-For-Service (PFFS) Plan
A type of Medicare Advantage Plan (Part C) in which you can generally go to any doctor or hospital you could go to if you had Original Medicare, if the doctor or hospital agrees to treat you. The plan determines how much it will pay doctors and hospitals, and how much you must pay when you get care. A Private Fee-For-Service Plan is very different than original Medicare, and you must follow the plan rules carefully when you go for health care services. Acts very much like a PPO plan.
Medicare Special Needs Plan (SNP)
A special type of Medicare Advantage Plan (Part C) that provides more focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
Nothing by mouth
A pharmacy that's part of a Medicare drug plan's network, but isn't a preferred pharmacy. You may pay higher out-of-pocket costs if you get your prescription drugs from a non-preferred pharmacy instead of a preferred pharmacy
A benefit that may be provided by your Medicare Advantage plan. Generally, this benefit gives you the choice to get plan services from outside of the plan's network of health care providers. In some cases, your out-of-pocket costs may be higher for an out-of-network benefit.
Patient controlled analgesic. IV medication delivered at a pre-selected frequency and is controlled partly by the patient.
Primary Care Provider
Power of attorney
A medical power of attorney is a document that lets you appoint someone you trust to make decisions about your medical care. This type of advance directive also may be called a health care proxy, appointment of health care agent, or a durable power of attorney for health care.
Physicians Orders for Life Sustaining Treatment
Approval that you must get from a Medicare drug plan or Private health plan before you fill your prescription for the prescription to be covered by your plan. Your Medicare drug plan may require prior authorization for certain drugs.
Q daily (q day):
Once a day
Four times a day
Temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient's caregiver can rest or take some time off.
Skilled Nursing Facility
Eligible days left for skilled nursing facility stay. 100 days at a time. Resets if
Patient is out of all facilities for 60 days or more.
State Health Insurance Assistance Program (SHIP)
A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.
Supplemental Security Income (SSI)
A monthly benefit paid by Social Security to people with limited income and resources who are disabled, blind, or age 65 or older. SSI benefits aren't the same as Social Security retirement or disability benefits.
A facility that is lower care than a hospital but higher in care than a SNF used mostly for ventilated patients or patients that require complex wound care or extensive antibiotics through an IV line.
Three times a day
Source: Center for Medicare and Medicaid Services. Dorland’s Medical Dictionary
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