Glossary

A group of data elements that represent core items of a comprehensive
assessment for an adult home care patient and form the basis for measuring
patient outcomes for purposes of outcome-based quality improvement (OBQI).
This assessment is performed on every patient receiving services of Home Health agencies that are approved to participate in the Medicare and/or Medicaid programs.

Data that measure the health status of people enrolled in managed care resulting from specific medical and health interventions (e.g. the incident of measles among plan enrollees during the calendar year).

An indicator that assesses what happens or does not happen to a patient following a process; agreed upon desired patient characteristics to be achieved; undesired patient conditions to be avoided.

The issuance of checks, disbursement of cash, or electronic transfer of funds made to liquidate an expense regardless of the fiscal year the service was provided or the expense was incurred. When used in the discussion of the Medicaid program, outlays refer to amounts advanced to the States for Medicaid benefits.

Additions to a full episode payment in cases where costs of services delivered are estimated exceed a fixed loss threshold. HH PPS outliers are computed as part of Medicare claims payment by Pricer Software.

Medical or surgical care that does not include an overnight hospital stay.

A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
Part of the Hospital providing services covered by SMI, including services in an emergency room or outpatient clinic, ambulatory surgical procedures, medical supplies such as splints, laboratory tests billed by the hospital, etc.

Medicare or surgical care that Medicare Part B helps pay for and does not include an overnight hospital stay, including:

• blood transfusions;
• certain drugs;
• hospital billed laboratory tests;
• mental health care;
• medical supplies such as splints and casts;
• emergency room or outpatient clinic, including same day surgery; and
• emergency room or outpatient clinic, including same day surgery; and
• x-rays and other radiation services.

The way that Medicare pays for most outpatient services at hospitals or community mental health centers under Medicare Part B.

A service you get in one day (24 hours) at a hospital outpatient department or community mental health center.