Evaluation conducted by a hospital or managed care plan to determine if the current place of service is the most appropriate to give the level of care needed by the patient. Also called utilization review (UR), utilization and management control, and medical review (UR).

Self-sufficient community that provides residential services (meals, housekeeping, laundry) and housing to meet the needs of elderly individuals. There is usually a large lump-sum entrance fee and a monthly fee. CCRCs provide independent living, intermediate and skilled nursing care, personal care, and organized social and recreational activities designed for participation in community life. Licensed as nursing homes/residential care facilities or as homes for the aging.

Insurance claim submitted for the same confinement or course of ongoing treatment for which a previous initial bill has been submitted. Such claims can be submitted every 30 or 60 days.

Formal education pursued by a working professional and intended to improve or maintain professional competence by obtaining current knowledge pertinent to the individual’s specific health care career. Also called continuing medical education.

Standardized data set created under the Deficit Reduction Act of 2005 and developed to unify and standardize federal assessment to improve continuity of care when patients transfer between providers and facilities. It is accessed through an Internet-based health and functional assessment instrument. This federal demonstration project will collect data until 2011.

Continued treatment of a patient who is referred by one physician to another for the same condition.

Subset of a patient’s health record that provides a basic set of information from one incident of care to another episode of care.

Health care contract in which benefits may be transferred from one plan to another without a lapse of coverage.

Type of kidney dialysis where the patient’s peritoneal membrane is used as the dialyzer. The patient dialyzes at home, using special supplies, but without the need for a machine.