Glossary
The words agencies work in, defined from the source.
Each term in a sentence or two, the regulation or document that defines it, and what it means for the record that has to be in hand.
Home health9
Comprehensive assessment
The full assessment of a home health patient's clinical, functional, cognitive and support status, including a drug regimen review and the OASIS items, completed within five calendar days after the start of care and updated at least every sixty days, after a hospital stay, and at discharge.
EpicCare Link
Epic's web portal for outside organizations. A health system grants a community provider or agency read access to its own patients' charts in that system's Epic. One account per health system, approved by that system on its own timeline, and showing only what that system holds.
Face-to-face encounter
A visit with a physician or allowed practitioner, related to the main reason the patient needs home health, that must occur within 90 days before or 30 days after the start of care and be documented in the certifying practitioner's own record. Without it Medicare does not pay for the episode.
Initial assessment visit
The agency's first visit, by a registered nurse or the appropriate rehabilitation clinician, to determine the patient's immediate care needs and Medicare eligibility. It must happen within 48 hours of the referral, within 48 hours of the patient's return home, or on the physician-ordered start-of-care date.
OASIS
The Outcome and Assessment Information Set: the standardized patient assessment a Medicare-certified home health agency collects at the start of care, resumption of care, recertification, transfer and discharge, and submits to CMS. It drives the publicly reported quality measures and the episode's payment grouping.
Plan of care
The written plan that sets what care a patient will receive, from whom, how often and toward what goals. In home health it is established and reviewed by the certifying practitioner; in PACE it is written by the interdisciplinary team; in structured family caregiving by the provider agency's nurse.
Referral packet
The set of documents a referral source sends a home health agency so care can start: the order, the face-to-face encounter note, the discharge summary, the history and physical, the medication list and the demographics. What arrives varies by source; what the agency needs does not.
Start of care
The date of the first billable home health visit, when the agency's clinician opens the episode, completes the Start of Care OASIS and begins the plan of care. Every clock in home health is measured from it, including the five days to the comprehensive assessment and the sixty-day certification period.
Timely Initiation of Care
A CMS home health quality measure: the percentage of episodes in which the start or resumption of care happened within two days of the referral date or the inpatient discharge date, whichever is later. It is reported publicly on Care Compare.
Case management4
Conflict-free case management
The federal requirement, in 42 CFR 441.301(c)(1)(vi), that the entity providing a Medicaid waiver member's case management or writing their service plan may not also provide their waiver services, or have an interest in a provider that does, unless the state shows no other willing and qualified entity exists.
Level-of-care form
The physician-signed instrument a state uses to determine that a Medicaid waiver applicant meets the nursing facility level of care: Georgia's Form 5588, Florida's 3008, Pennsylvania's MA 570, Michigan's LOCD and their counterparts. It needs clinical documentation behind it and reaches a state validator on a clock.
Medicaid waiver case management agency
The organization a state's Medicaid waiver authorizes to take applications, coordinate the level-of-care determination, write the person-centered service plan and arrange services. States call it case management, support coordination or service coordination; under federal rule it may not also be the member's provider.
Nursing facility level of care
The eligibility threshold for Medicaid home and community-based waivers and for PACE: the person's needs would qualify them for care in a nursing facility, and they are served at home instead. Each state defines the criteria and determines it on a physician-signed instrument supported by clinical documentation.
PACE5
Initial comprehensive assessment
The in-person assessment the PACE interdisciplinary team must complete on every new participant under 42 CFR 460.104: eight disciplines each evaluate the participant and write a discipline-specific assessment across eleven domains, and the team consolidates them into one plan of care within 30 days of enrollment.
Interdisciplinary team
The team a PACE organization must maintain for each participant under 42 CFR 460.102, responsible for assessing the participant, developing the plan of care and delivering or arranging every service in it. Its members span primary care, nursing, social work, therapy, nutrition, activities, home care and transportation.
PACE
The Program of All-Inclusive Care for the Elderly: a Medicare and Medicaid benefit under 42 CFR Part 460 in which one organization takes clinical and financial responsibility for a participant aged 55 or over who meets the state's nursing facility level of care and can live safely in the community.
PACE enrollment
How a person becomes a PACE participant: intake visits, a signed release so the organization can obtain medical and financial information, the state's level-of-care assessment, the organization's own safety assessment, and a signed enrollment agreement, effective the first day of the following month.
State administering agency
The state agency responsible for PACE in that state. Under 42 CFR 460.150 and 460.152 it determines whether a prospective participant needs the nursing facility level of care, Medicaid-eligible or not, and under 460.160 it reevaluates that at least annually. States delegate the assessment in different ways.
Structured family caregiving1
Chart prep1
Care coordination1
Exchange, privacy and the record13
Business associate agreement
The contract HIPAA requires between a covered entity and a vendor that creates, receives, maintains or transmits protected health information on its behalf. It binds the vendor to the Privacy and Security Rules, sets what it may do with the data, and makes it directly liable for breaches.
C-CDA
Consolidated Clinical Document Architecture: the HL7 standard for the clinical documents EHRs exchange, including the Continuity of Care Document. It is what a network query returns: structured sections for problems, medications, allergies, results, procedures and encounters, with the narrative beside them.
Carequality
An interoperability framework, run by The Sequoia Project, under which networks, EHR vendors and other implementers agree to one set of legal and technical terms, so a participant in one can query records held by a participant in any other, for a permitted purpose such as treatment.
CommonWell Health Alliance
A not-for-profit health data network whose members, mostly EHR vendors, link patient identities and exchange clinical documents across their systems. It connects to Carequality so its participants and Carequality's can reach each other, and it is a designated Qualified Health Information Network under TEFCA.
Discharge summary
The hospital's account of a stay: why the patient was admitted, what was found and done, the condition at discharge, the medications at discharge and the follow-up arranged. Hospitals must produce one for the record; whether the receiving agency has it before the start of care is another matter.
Health information exchange
The movement of clinical information between organizations electronically, and the name for a regional or state body that runs such a service. National exchange runs over Carequality, CommonWell and TEFCA; a state HIE is one more source a query may reach, often the only one holding a small practice's records.
Medical record retrieval
Obtaining a patient's records from the organizations that hold them. Two routes share the name: a written request under release of information, which legal and payer vendors sell, and provider-to-provider exchange for treatment, which a treating provider can do without an authorization. Vivlio does the second.
Network query
A request sent across an exchange network for the documents every connected organization holds on one patient, under a stated purpose of use. One query reaches every connected source at once; what comes back is documents, each carrying the organization that released it and the date.
NPI
The National Provider Identifier: the ten-digit number HIPAA assigns to every health care provider, individual or organization, for use in standard transactions. On the exchange networks it is how a querying provider identifies itself, and a treatment query is made under a provider's NPI.
Outside records
Records created by another organization: the hospital's discharge summary, the specialist's consult, the lab's results, the prior practice's chart. They are the part of a patient's history the agency's own system does not hold, and the part that has to be requested or queried before the visit or the plan of care.
Release of information
The process by which a records holder discloses a patient's records on a written request: the patient's own right of access, or an authorization the patient signs for a third party such as an attorney or insurer. It is the route legal and payer vendors use. Provider-to-provider exchange for treatment does not need it.
TEFCA and QHINs
The Trusted Exchange Framework and Common Agreement is the federal framework for nationwide health information exchange under the 21st Century Cures Act. Qualified Health Information Networks are the networks designated to exchange under it for their participants; the first were designated in December 2023.
Treatment purpose of use
The HIPAA basis on which one provider may disclose a patient's records to another without the patient's authorization: the disclosure is for the treatment activities of a health care provider. On the exchange networks it is the purpose a querying organization asserts, and a treating provider is who may assert it.
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