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HCFA 1500
The Health Care Finance Administration's standard form for submitting
physician service claims to third party (insurance) companies.
Health Maintenance Organization (HMO)
HMOs offer prepaid, comprehensive health coverage for both hospital
and physician services. An HMO contracts with health care providers,
e.g., physicians, hospitals, and other health professionals, and
members are required to use participating providers for all health
services. Members are enrolled for a specified period of time.
Model types include staff, group practice, network and IPA (for
additional information, see staff, group, network and IPA model
definitions).
Health Plan Employer Data and Information Set (HEDIS)
A set of performance measures designed to standardize the way
health plans report data to employers. HEDIS currently measures
five major areas of health plan performance: quality, access and
patient satisfaction, membership and utilization, finance, and
descriptive information on health plan management.
Health and Human Services, The Department of (HHS)
The Department of Health and Human Services which is responsible
for health-related programs and issues. Formerly HEW, the Department
of Health, Education, and Welfare. The Office of Health Maintenance
Organizations (OHMO) is part of HHS and detailed information on
most companies is available here through the Freedom of Information
Act.
Health Partnership Program (HPP)
Health Partnership Program, administered by the Ohio Bureau of Workers'
Compensation, is the new medical managed care for State Insurance
Fund employers designed to provide quality medical care for Ohio's
injured workers.
Hold Harmless Clause
A clause frequently found in managed care contracts whereby the
HMO and the physician hold each other not liable for malpractice
or corporate malfeasance if either of the parties is found to
be liable. Many insurance carriers exclude this type of liability
from coverage. It may also refer to language that prohibits the
provider from billing patients if their managed care company becomes
insolvent. State and federal regulations may require this language.
Home Health Care
Full range of medical and other health related services such as
physical therapy, nursing, counseling, and social services that
are delivered in the home of a patient, by a provider.
Hospital
Any institution duly licensed, certified, and operated as a Hospital.
In no event shall the term "Hospital" include a convalescent
facility, nursing home, or any institution or part thereof which
is used principally as a convalescence facility, rest facility,
nursing facility, or facility for the aged.
Hospital Affiliation
A contractual agreement between an HMO and one or more hospitals
whereby the hospital provides the inpatient benefits offered by
the HMO.
Hospital Audit Companies
Retrospective audit providers that typically achieve a 15-20 percent
savings of billed claims.
Hospital Days Per 1,000
A measurement of the number of days of hospital care HMO members
use in a year. It is calculated as follows: Total Number Of Days
Spent In A Hospital By Members divided by Total Members. This
information is available through HHS, OHMO and a variety of sources.
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