Potential flaw in management controls requiring management attention and possible corrective action.

State program that helps high-risk individuals who have health problems to join together to purchase health insurance. However, because the pool members are high risk, the insurance premium rates are high even with state subsidies.

In CPT coding of a service or procedure, this is a problem where the risk of morbidity without treatment is high to extreme. There is a moderate to high risk of mortality without treatment or high probability of severe, prolonged functional impairment.

Legislation and the programs operated under that legislation for federal support of constructing new and modernizing existing hospitals and other health facilities, beginning with Public Law 79-725, the Hospital Survey and Construction Act of 1946. The original law, which has been amended, provided for surveying state needs, developing plans for construction of hospitals and public health centers, and assisting in construction and equipping them in exchange for the hospitals’ commitment to give free or discounted fees for services to individuals who cannot afford treatment. The Department of Health and Human Services (HHS) issued regulations that established standards for uncompensated care. It stated that care given to Medicare and Medicaid patients was not considered uncompensated care. Until the late 1960s, most of the amendments expanded the program in dollar amounts and scope. The administration has attempted to terminate the program, while Congress has tried to restructure it toward support of outpatient facilities, facilities to serve areas deficient in health services, and training facilities for health and allied health professions. The purpose of the existing Hill-Burton program was modified by Public Law 93-641 to allow assistance in the form of grants, loans, or loan guarantees for the following purposes: modernization of health facilities; construction of outpatient health facilities; construction of inpatient facilities in areas that have experienced rapid population growth; and conversion of existing medical facilities for the provision of new health services.

Data dictionary that defines and cross-references the contents of all X12 transactions included in the Health Insurance Portability and Accountability Act (HIPAA) mandate. It is maintained by X12N/TG3.

Acronym that means health insurance purchasing cooperatives. See consumer health alliances .

Pertaining to the study of the microscopical, anatomical, and physiological characteristics of tissues and the cells found therein.

Cost information submitted by providers when submitting Medicare claims that is used to determine the future cost of medical professional services (referred to as rate setting ).

1. Record of past events. 2. Systematic account of the medical, emotional, and psychosocial occurrences in a patient’s life and of factors in the family, ancestors, and environment that may contribute to a patient’s condition.

Detailed account obtained during an interview with the patient of the onset, duration, and character of the present illness and any acts or factors that aggravate or ameliorate the symptoms, as well as the findings on physical examination. Then the physician makes a medical decision based on the number of diagnoses or management options, amount of data or complexity of data reviewed, and complications and/or morbidity or mortality. An H & P may be performed before or on the day of admission as an inpatient to the hospital.