Glossary

Advance Directive – a written or oral statement of the kind of medical care you want or do not want if you become unable to make your own decisions. May also be referred to as a living will because it takes effect while you are still living.

AHCA – Agency for Health Care Administration is the state agency that licenses hospitals in Florida.

AHRQ – Agency for Healthcare Research and Quality is a federal agency that conducts healthcare research and creates tools for healthcare providers.

Billing Statement - shows the dates of service, the amount billed, the account status, the amount paid by the insurer, and the balance due from the patient. Billing statements are issued on a hospital-determined frequency, often monthly.

Board Certified – most commonly refers to physicians who have passed a variety of exams, or boards, in a field of medicine. All doctors must pass boards before obtaining their licenses to practice medicine. However, physicians often want to specialize in a particular field and pursue further study before taking boards in specialized medicine.

Charge – the “retail” price for a service and does not reflect any discounts or set rates paid by Medicare, Medicaid or health insurance companies.

CMS – Centers for Medicare & Medicaid Services is a federal agency that administers Medicare and the federal component of the Medicaid program.

COB - Coordination of Benefits - occurs when a patient/insured has two or more health insurance policies providing hospital coverage.

Coinsurance – the share of covered expenses, expressed as a percentage that the patient must pay in addition to any applicable deductible for services provided.

Copayment - represents an amount, expressed as a flat dollar amount, specified by the insured’s health plan that the patient must pay for services provided.

Deductible - the initial amount that the patient will have to pay before benefits are paid under the insurance policy.

DFS – Department of Financial Services is the state agency that licenses and monitors health insurance companies in Florida.

DOH - Department of Health is the state agency that licenses physicians and other healthcare professionals in Florida.

DRG – Diagnosis Related Group – a unit of payment for Medicare inpatient services.

EOB – Explanation of Benefits – details the amount paid on behalf of a patient by their health insurance plan.

HMO – Health Maintenance Organization - a prepaid healthcare plan where people enroll by paying a set annual fee. Medical services are provided through a group of affiliated physicians and hospitals, often with no additional copayment or fees.

Inpatient Surgery – a surgery performed in the hospital that requires the patient to be admitted for overnight care.

Itemized Bill - specific details on the services provided, including dates and charges for each item of service. Hospitals are required to provide an itemized bill if the patient requests it.

JCAHO – Joint Commission on Accreditation of Healthcare Organizations - A private not-for-profit organization that establishes standards for the operation of health facilities and services, conducts surveys, and awards accreditation for those that meet the standards.

Long-Term Acute Care Hospital – a hospital in which the average length of stay exceeds 25 days.

Medicaid – a state–administered medical program that serves low-income families, people who are over 65 and older, people who are blind and who are disabled.

Medicare – a federal health insurance program that serves people 65 and older, or disabled persons, regardless of income.

NCQA – National Committee for Quality Assurance is a not-for-profit organization that monitors, accredits and provides quality measures on managed care companies.

Neonatal Intensive Care (NICU) Level II – services which include the provision of ventilator services and at least six hours of nursing care per day.

Neonatal Intensive Care (NICU) Level III – services which include the provision of continuous cardiopulmonary support services, 12 or more hours of nursing care per day, complex pediatric surgery, neonatal cardiovascular surgery, pediatric neurology and neurosurgery, and pediatric cardiac catheterization.

OIR – Office of Insurance Regulation is an agency under DFS that monitors health insurance companies in Florida.

Out-of-Pocket Costs - the portion of health services and costs that must be paid by the patient.

Outpatient Surgery – a patient not admitted to the hospital but who receives healthcare services.

Patient Responsibility – the portion of the charges that are paid by the patient, not by the health insurance plan.

Patient’s Bill of Rights – passed by the Florida Legislature to promote better communication between the patient and the healthcare provider.

Pediatric Trauma Center - a hospital which is determined by the Department of Health to be in substantial compliance with pediatric trauma referral center standards as established by rule of the department.

Statewide Subscriber Assistance Program Panel – a Florida program to provide assistance to plan members and providers whose grievances are not resolved to their satisfaction.

Summary Bill - total charges for the hospital visit and is what is submitted to the insurer. Summary bills are often consolidated at a service category level, such as room and board, pharmacy, laboratory and operating room.

Trauma Center Level I – a hospital which has formal research and education programs for the enhancement of trauma care (i.e., teaching hospitals); serves as a resource facility to Level II trauma centers, pediatric referral centers and general hospitals through shared outreach, education and quality improvement activities; participates in an inclusive system of trauma care, including providing leadership, system evaluation and quality improvement activities. Level I includes pediatric trauma designation.

Trauma Center Level II– a hospital which is determined by the Department of Health to be in substantial compliance with Level II trauma center standards; serves as resource facility to general hospitals through shared outreach, education and quality improvement activities; participates in an inclusive system of trauma care.