The Business Glossary · Health Tech

Accounting of disclosures: the list a patient may request of who outside the practice received their information for purposes other than treatment, payment and operations, over the past six years, answered within 60 days; the disclosures table (The Health Tech Business).
Allowed amount: what a payer's contract or fee schedule says a service is worth; the payer and the patient split it, and the rest of the charge is written off (The Health Tech Business).
Appointment: a booking for a patient at a time with a practitioner and resources; the plan, as distinct from the encounter that happened (The Health Tech Business).
BAA (business associate agreement): the contract HIPAA requires before PHI is shared with a business associate, listing permitted uses, safeguards, breach reporting, subcontractor terms and return or destruction at termination (Selling Software into Health Care).
Business associate: a person or company that creates, receives, maintains or transmits PHI on behalf of a covered entity, including its subcontractors that do the same (Selling Software into Health Care).
Capitation: a fixed payment per member per month to a provider or plan, whether or not the member receives care (The Health Tech Business).
Charge: a billable line from a procedure at the practice's fee, billed to a payer or the guarantor (The Health Tech Business).
Claim: a bill to one payer for one patient's services under one coverage, sent as an X12 837 (The Health Tech Business).
Clearinghouse: a company that routes and checks claims, eligibility checks, claim status and remittances between providers and payers (The Health Tech Landscape).
Collection ratio: collections over net production for a period; how much of what the practice earned it actually received (The Practice Business).
Collections: payments received from patients and payers, summed from the ledger (The Practice Business).
Contractual adjustment: the write-off of the difference between a practice's charge and a payer's allowed amount, agreed by contract (group code CO) (The Health Tech Business).
Corporate practice doctrine: state law barring lay corporations from practicing medicine, dentistry or veterinary medicine or employing licensees to do it, the reason MSOs and DSOs exist (The Practice Business).
Coverage: a patient's insurance under a plan, with member ID, subscriber, relationship and order (primary, secondary) (The Health Tech Business).
Covered entity: a health plan, a clearinghouse, or a provider that conducts HIPAA standard transactions such as claims electronically (The Health Tech Business).
DSO (dental service organization): a company that provides business services to dental practices under management agreements, with licensed dentists owning the clinical entities (The Practice Business).
Encounter: a visit where care was delivered, in person or virtual; what claims and the clinical record run on (The Health Tech Business).
Fee schedule: a set of fees by procedure code: the practice's own office fees, or a payer's contracted or published amounts (The Practice Business).
Guarantor: the person or organization responsible for a patient's bill: the patient, a parent, a spouse, or for a veterinarian the client (The Health Tech Business).
HBNR (Health Breach Notification Rule): the FTC rule (16 CFR Part 318) requiring vendors of personal health records outside HIPAA to notify people, the FTC and sometimes the media of breaches, including unauthorized sharing (Selling Software into Health Care).
HITRUST: a security assessment and certification framework common in health care, in e1, i1 and r2 tiers (Selling Software into Health Care).
Ledger entry: an append-only posting of a charge, payment, adjustment, write-off, refund or transfer to a guarantor's account; balances are sums of entries (The Health Tech Business).
MSO (management services organization): a company providing the business side of a medical practice under a management agreement while licensees own the practice (The Practice Business).
NPI (National Provider Identifier): the 10-digit identifier with a check digit that HIPAA assigns to health care providers, type 1 for individuals and type 2 for organizations (The Health Tech Business).
Patient: the person receiving care, or for a veterinarian the animal (The Health Tech Business).
Patient responsibility: the part of an allowed amount the patient owes under the plan design (deductible, copay, coinsurance), group code PR on the remittance (The Health Tech Business).
Payer: an insurer, government program or plan administrator that pays claims (The Health Tech Business).
Percentage of collections: a revenue cycle vendor's fee computed as a share of the payments it collects for the customer (Business Models for Health Software).
PHI (protected health information): individually identifiable health information held by a covered entity or business associate (Selling Software into Health Care).
PMPM (per member per month): a fee or payment computed on the number of covered members each month, as in enterprise telehealth access fees and capitation (Business Models for Health Software).
Practitioner: a licensed person who delivers care; the NPI belongs to them (The Health Tech Business).
Practitioner role: a practitioner at an organization and location, with specialty and taxonomy code; claims name the rendering role (The Health Tech Business).
Procedure: a service planned or performed, with its CPT, CDT, HCPCS or local code; clinical, as distinct from its charge (The Health Tech Business).
Production: the practice's fees for completed procedures in a period, gross or net of PPO write-offs and adjustments (The Practice Business).
QHIN (Qualified Health Information Network): a network designated to exchange records under TEFCA (The Health Tech Landscape).
Recall: the recurring visit a patient is due for (a cleaning, an annual exam, a vaccine), with a due date computed from the last completed procedure (The Practice Business).
Remittance: a payer's payment and explanation across claims, sent as an X12 835 (The Health Tech Business).
Scheduled production: the fees of treatment-planned procedures attached to scheduled appointments; what the schedule is worth if everyone shows (The Practice Business).
Self-funded plan: an employer health plan where the employer bears the claims cost and an insurer or TPA administers it under ERISA (The Health Tech Business).
Subscriber: the person who holds the insurance policy a patient is covered under (The Health Tech Business).
Taxonomy code: a ten-character NUCC code describing a provider's type and specialty (The Health Tech Business).

Accounting of disclosures: the list a patient may request of who outside the practice received their information for purposes other than treatment, payment and operations, over the past six years, answered within 60 days; the disclosures table (The Health Tech Business).
Allowed amount: what a payer's contract or fee schedule says a service is worth; the payer and the patient split it, and the rest of the charge is written off (The Health Tech Business).
Appointment: a booking for a patient at a time with a practitioner and resources; the plan, as distinct from the encounter that happened (The Health Tech Business).
BAA (business associate agreement): the contract HIPAA requires before PHI is shared with a business associate, listing permitted uses, safeguards, breach reporting, subcontractor terms and return or destruction at termination (Selling Software into Health Care).
Business associate: a person or company that creates, receives, maintains or transmits PHI on behalf of a covered entity, including its subcontractors that do the same (Selling Software into Health Care).
Capitation: a fixed payment per member per month to a provider or plan, whether or not the member receives care (The Health Tech Business).
Charge: a billable line from a procedure at the practice's fee, billed to a payer or the guarantor (The Health Tech Business).
Claim: a bill to one payer for one patient's services under one coverage, sent as an X12 837 (The Health Tech Business).
Clearinghouse: a company that routes and checks claims, eligibility checks, claim status and remittances between providers and payers (The Health Tech Landscape).
Collection ratio: collections over net production for a period; how much of what the practice earned it actually received (The Practice Business).
Collections: payments received from patients and payers, summed from the ledger (The Practice Business).
Contractual adjustment: the write-off of the difference between a practice's charge and a payer's allowed amount, agreed by contract (group code CO) (The Health Tech Business).
Corporate practice doctrine: state law barring lay corporations from practicing medicine, dentistry or veterinary medicine or employing licensees to do it, the reason MSOs and DSOs exist (The Practice Business).
Coverage: a patient's insurance under a plan, with member ID, subscriber, relationship and order (primary, secondary) (The Health Tech Business).
Covered entity: a health plan, a clearinghouse, or a provider that conducts HIPAA standard transactions such as claims electronically (The Health Tech Business).
DSO (dental service organization): a company that provides business services to dental practices under management agreements, with licensed dentists owning the clinical entities (The Practice Business).
Encounter: a visit where care was delivered, in person or virtual; what claims and the clinical record run on (The Health Tech Business).
Fee schedule: a set of fees by procedure code: the practice's own office fees, or a payer's contracted or published amounts (The Practice Business).
Guarantor: the person or organization responsible for a patient's bill: the patient, a parent, a spouse, or for a veterinarian the client (The Health Tech Business).
HBNR (Health Breach Notification Rule): the FTC rule (16 CFR Part 318) requiring vendors of personal health records outside HIPAA to notify people, the FTC and sometimes the media of breaches, including unauthorized sharing (Selling Software into Health Care).
HITRUST: a security assessment and certification framework common in health care, in e1, i1 and r2 tiers (Selling Software into Health Care).
Ledger entry: an append-only posting of a charge, payment, adjustment, write-off, refund or transfer to a guarantor's account; balances are sums of entries (The Health Tech Business).
MSO (management services organization): a company providing the business side of a medical practice under a management agreement while licensees own the practice (The Practice Business).
NPI (National Provider Identifier): the 10-digit identifier with a check digit that HIPAA assigns to health care providers, type 1 for individuals and type 2 for organizations (The Health Tech Business).
Patient: the person receiving care, or for a veterinarian the animal (The Health Tech Business).
Patient responsibility: the part of an allowed amount the patient owes under the plan design (deductible, copay, coinsurance), group code PR on the remittance (The Health Tech Business).
Payer: an insurer, government program or plan administrator that pays claims (The Health Tech Business).
Percentage of collections: a revenue cycle vendor's fee computed as a share of the payments it collects for the customer (Business Models for Health Software).
PHI (protected health information): individually identifiable health information held by a covered entity or business associate (Selling Software into Health Care).
PMPM (per member per month): a fee or payment computed on the number of covered members each month, as in enterprise telehealth access fees and capitation (Business Models for Health Software).
Practitioner: a licensed person who delivers care; the NPI belongs to them (The Health Tech Business).
Practitioner role: a practitioner at an organization and location, with specialty and taxonomy code; claims name the rendering role (The Health Tech Business).
Procedure: a service planned or performed, with its CPT, CDT, HCPCS or local code; clinical, as distinct from its charge (The Health Tech Business).
Production: the practice's fees for completed procedures in a period, gross or net of PPO write-offs and adjustments (The Practice Business).
QHIN (Qualified Health Information Network): a network designated to exchange records under TEFCA (The Health Tech Landscape).
Recall: the recurring visit a patient is due for (a cleaning, an annual exam, a vaccine), with a due date computed from the last completed procedure (The Practice Business).
Remittance: a payer's payment and explanation across claims, sent as an X12 835 (The Health Tech Business).
Scheduled production: the fees of treatment-planned procedures attached to scheduled appointments; what the schedule is worth if everyone shows (The Practice Business).
Self-funded plan: an employer health plan where the employer bears the claims cost and an insurer or TPA administers it under ERISA (The Health Tech Business).
Subscriber: the person who holds the insurance policy a patient is covered under (The Health Tech Business).
Taxonomy code: a ten-character NUCC code describing a provider's type and specialty (The Health Tech Business).