With obscure acronyms and confusing terms that vary from one state to the next, the homecare industry can be very confusing. This concise guide defines key terms and acronyms and provides links to relevant websites for more detailed information.
In homecare, the Activities of Daily Living include bathing, eating, dressing, using the restroom and moving around. More complex activities, such as managing money and healthcare, driving, and cooking are regarded as Instrumental Activities of Daily Living (IADLs). A plan of care can be created for an individual based on how much support they need to accomplish their ADLs and IADLs.
The ADA is a U.S. law that prohibits discrimination against people with disabilities in the workplace, school, transportation services, and several other public spaces.
An EVV aggregator is selected by state agencies to collect EVV data that vendors are required to report to the state.
The Agency for Health Care Administration (AHCA) is responsible for the administration of the Florida Medicaid program, licensure, and regulation of Florida’s health facilities and for providing information to Floridians about the quality of care they receive. Florida Agency for Health Care Administration: https://ahca.myflorida.com/
An Application Programing Interface (API) is a set of commands that allows two or more software applications to communicate. The API specifies how software components should interact and are used when programming graphical user interface (GUI) components.
ARPA funding is federal funding allocated to support healthcare providers, including those in homecare, during public health emergencies. It may be used for various purposes, such as expanding services or improving infrastructure.
The Payer determines the services/treatment to be provided to a Patient, as well as the frequency and time frame. Service Providers must abide by the authorization terms for the reimbursement of invoices. Non-authorized services may not be covered, and reimbursement may be denied accordingly by the Payers.
Refers to the Aide, Homecare Aide, Homecare Worker, or Worker. The Caregiver is the person providing services.
Home Health Aides (HHAs) and Personal Care Assistants (PCAs) who work for agencies funded by Medicare or Medicaid must meet minimum standards of training, or certification. Training standards include 75 hours of training, 16 hours of supervised practical work, passing a competency evaluation or state certification program. Check specific state requirements for more information.
Related: Skilled, Non-Skilled Caregiver Certification.
Caregiver burnout occurs when individuals providing care to loved ones or clients experience physical, emotional, or mental exhaustion due to the demands of caregiving.
Case broadcasting is a communication method used in homecare to broadcast open shifts to all caregivers or communicate securely with select caregivers via text, email, or phone.
The Consumer Directed Personal Assistance Program (CDPAP) is a New York state Medicaid program arranged by a state authorized home healthcare agency in which the Patient (or relative) directs how, when and by who they receive personal homecare assistance from. Under the guidelines of CDPAP, Patients can opt to have a friend, relative, neighbor, or previously hired Caregiver to act as their personal assistant, instead of an Agency-provided Caregiver.
The Consumer Directed Personal Assistance Services (CDPAS) refers to the services offered within a program.
Consumer Directed Services or Self-Directed Medicaid Services or refers to when participants (or their representatives) have decision-making authority over certain services and take responsibility for managing their services with assistance of an available support system. This Self-Directed Service Model is an alternative to traditionally delivered and managed services (such as an Agency Delivery Model).
With Self-Direction Services, participants have the responsibility of managing all aspects of service delivery in a person-centered planning process.
Related: CDPAP/CDPAS.
The total number of clients that a homecare agency serves monthly. The active census is the number of clients with an active schedule for the agency in each month.
A Certified Home Health Agency (CHHA) provides what are commonly known as “visiting nurse” services, as well as physical or occupational or speech therapy (PT/OT) in the home, “home health aide” (HHA) services, and medical supplies. CHHAs are also known as Payers or Contracts (in HHAeXchange).
NYS Health Profiles: https://profiles.health.ny.gov/home_care/pages/chha
A request for payment that a Patient or health care Provider submits to a Payer for items or services rendered.
Related: Provider, Payer.
A clearinghouse in homecare is a centralized entity that facilitates the electronic exchange of healthcare information, including claims processing and billing between Providers and Payers.
Related: EDI.
Clinical documentation is a record of medical treatments, medical trials, or clinical tests. Clinical documentation is used to facilitate Provider communication, allow evidence-based healthcare systems to automate decisions, provide evidence for legal records and create patient registry functions so public health agencies can manage and research large patient populations more efficiently.
Related: Providers.
In a closed EVV model, a state Medicaid program contracts with a single EVV vendor and mandates all Provider agencies use that vendor’s EVV system.
Related: Open State Model.
The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services responsible for administration of several key federal health care programs. In addition to Medicare and Medicaid, CMS also oversees the Health Insurance Portability and Accountability Act (HIPAA), among other services.
Centers for Medicare & Medicaid Services: http://www.cms.gov/About-CMS/About-CMS.html
Health insurance provided and administered by non-governmental entities; any type of health benefit not obtained from Medicare or Medicaid. The insurance may be employer-sponsored or privately purchased.
Compliance in homecare refers to adhering to laws, regulations, and industry standards to ensure the delivery of safe and high-quality care while also meeting documentation and reporting requirements.
See definition for Patient.
Consumer Directed Care (CDC) allows an elderly or disabled person to choose their own homecare providers, set their schedules, and assign tasks. With CDC consumers are in control of their own care and can select trusted friends or relatives the ability to serve as caregivers.
Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. CPT is a numeric coding system maintained by the American Medical Association (AMA).
CPT® (Current Procedural Terminology): https://www.ama-assn.org/amaone/cpt-current-procedural-terminology
The 21st Century Cures Act (Cures Act), signed into law on December 13, 2016, was designed to help accelerate medical product development and bring new innovations and advances to Patients who need them faster and more efficiently.
To eliminate fraud, waste, and abuse, part of the Cures Act required that Providers of Personal Care Services confirm visits via Electronic Visit Verification (EVV) by January 1, 2020.
Cures Act: https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-centurycures-act
Related: Closed State Model, EVV, Open State Model.
Medical treatment and/or services provided by healthcare Providers that are deemed non-covered and/or payable by the Patient’s health insurance company (plan). A variety of reasons may result in denials such as a Patient’s lack of health insurance coverage, untimely submission of invoices, a non-covered or not medically necessary treatment/service according to the Patient’s benefit plan, and lack of compliance with rules/regulation governing the proper invoice/file submission by the healthcare Provider.
The Department of Medical Assistance Services (DMAS) is the agency that administers all Medicaid and FAMIS health insurance benefit programs in Virginia. Families and individuals meeting income and other eligibility requirements may be eligible to receive health benefits through a variety of programs.
Virginia Department of Medical Assistance Services: https://www.dmas.virginia.gov/
When a Patient qualifies for both Medicare and Medicaid benefits. This usually occurs in situations where a Patient already qualifies for Medicare but because of low income, cannot afford the remaining costs such as deductibles (the Patient portion of the medical bills).
Electronic Data Interchange (EDI) is the electronic interchange of information using a standardized format; a process which allows one company to send information to another company electronically rather than with paper.
Related: FTP, SFTP.
The EDI 276 transaction set is a health care claim status inquiry used by healthcare Providers to verify the status of a claim submitted previously to a Payer, such as an insurance company, HMO, government agency (such as Medicare or Medicaid). The Payer provides the information in response to the 276 request using a 277 Claim Status Response transaction.
After services are rendered, providers can submit an electronic claim (837 file) to payers to be reimbursed. In return, payers send providers an Electronic Remittance Advice (ERA), or 835 file, which provides claim payment information. Each file type has specific HIPAA 5010 requirements for the electronic transmission of healthcare payment and benefit information.
The claim information included amounts to the following, for a single care encounter between patient and provider:
When a provider submits an 837, the insurance plan uses the 835 to detail the payment to that claim, including:
The Explanation of Benefits (EOB) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment.
An EOB typically includes the following information:
Electronic Visit Verification (EVV) is a technology solution where homecare services are captured and verified via vendor system. With the passing of the 21st Century Cures Act, Medicaid homecare providers are required to implement EVV. As part of this Act, visits must be electronically verified for the type, date, and location of service performed, the individual receiving the service, the caregiver performing the service, and the time service begins and ends.
https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html
Related: Closed State Model, Cures Act, Open State Model.
Federal and state-specific lists showing Caregivers and Physicians who are excluded from federally funded programs.
Related: Verification Lists.
Fee for Service (FFS) is the most traditional payment model of healthcare where providers are reimbursed based on the number of services provided or procedures performed. This payment model rewards volume and quantity of services provided, regardless of the outcome.
FMSAs are the vendor fiscal/employer agents for people who hire their own employees for certain services, also called CDS employers. FMSAs provide payroll services as well as deposit and report withholding taxes on behalf CDS employers.
Related Financial Management Service.
A fob is a small device used for Electronic Visit Verification (EVV) when a patient is out of cell phone range. Also called an Alternative Device (AD).
The File Transfer Protocol (FTP) is a standard network protocol used for the transfer of computer files between a client and server on a computer network. FTP is built on a client-server model architecture using separate control and data connections between the client and the server.
Related: EDI, SFTP.
Activities in healthcare that are fraudulent, wasteful, or abusive, such as overbilling for services or providing unnecessary care.
Medicaid home and community-based services (HCBS) allow Medicaid recipients to receive care in their own homes and communities.
HCBS waivers are programs within Medicaid that provide additional services and support to individuals who require long-term care but wish to remain in their homes or communities instead of moving to institutions like nursing homes.
Health equity involves providing equal access to healthcare services and addressing disparities in care outcomes, regardless of a patient’s race, ethnicity, socioeconomic status, or other factors.
A health insurance waiver is a document that when signed provides the option to opt-out of a health insurance plan offered to a Consumer by making a formal request. This could apply to health insurance group plan that a Consumer is being offered as part of a program, an employer, school, or other organization.
The HETS 270/271 application allows providers or clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. The 270 is the inquiry used to request information from a healthcare insurance plan about a policy’s coverages, typically in relation to a particular plan subscriber. The 271 is the Health Care Eligibility/Benefit Response and is used to transmit the information requested in a 270.
The Health Insurance Portability and Accountability Act (HIPAA), signed into law in 1996, is a legislation which provides security provisions and data privacy, in order to keep Patients’ medical information safe. The HIPAA Privacy Rule is enforced by the Office of Civil Rights which sets national standards for the security of electronic Protected Health Information (PHI); the HIPAA Breach Notification Rule which requires covered entities and business associates to provide notification following a breach of unsecured PHI; and the confidentiality provisions of the Patient Safety Rule, protecting identifiable information used to analyze Patient safety events as well as the improvement of Patient safety.
A Health Maintenance Organization (HMO) is a type of managed care that has its own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its Members.
See definition for Caregiver.
Represents a wide range of services that can be given in a Patient’s home for an illness or injury. Homecare is typically less expensive and more convenient and can be just as effective as care offered in a hospital or Skilled Nursing Facility (SNF).
Homecare: https://www.medicare.gov/what-medicare-covers/whats-home-health-care
Homecare management software, like HHAeXchange, connects providers, state Medicaid programs, managed care organizations (MCOs), and caregivers. It automates tasks such as caregiver scheduling, billing, and record-keeping, and can help track patient progress and identify potential problems.
Hospice is specialized type of care for those facing a life-limiting illness (chronic and/or terminal), their families and their Caregivers. Hospice care addresses the Patient’s physical, emotional, social, and spiritual needs. Hospice care also helps the Patient’s family Caregivers.
The U.S. Citizenship and Immigration Services (USCIS) Form I-9 is used to verify the identity and employment authorization of individuals hired for employment in the United States. All U.S. employers must ensure proper completion of Form I-9 for each individual they hire for employment in the United States. This includes citizens and noncitizens. Refer to the following link to view document requirements:
Employment Eligibility Verification: https://www.uscis.gov/i-9
The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. Replacement for ICD-9 Codes.
The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Refer to the following link to understand the key differences and changes from ICD-9 to ICD-10.
Key Differences and Changes ICD-9 to ICD-10: https://www.ama-assn.org/media/7546/download (PDF)
The International Classification of Diseases Clinical Modification, 9th Revision (ICD-9 CM) is a list of codes intended for the classification of diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease; standard list of six-character alphanumeric codes to describe diagnoses. ICD-9 was replaced by ICD-10 on October 1, 2015.
Related: ICD-10.
An In-Service program is a professional training or staff development effort, where professionals are trained and discuss their work with others in their peer group. It is a key component of continuing medical education for Caregivers. In-Service refers to any form of on-the-job training, i.e., In-Service training of a Caregiver, often delivered by the employing Agency.
The fundamental principle of the Independent Living movement is that people with disabilities are entitled to the same civil rights, options, and control over choices in their own lives as people without disabilities. This movement lead to the creation of self-directed care.
Individual Budget is an allocated amount of funds that a self-direction participant can use to hire workers and/or purchase other goods and services to meet their support needs. Akin to an authorization.
Interactive Voice Response (IVR), also called telephony, is a technology that allows customers to interact with a company’s host system (in this case, HHAeXchange) via a telephone keypad or by speech recognition. IVR systems can respond with pre-recorded or dynamically generated audio to further direct users on how to proceed.
A Licensed Home Care Service Agency (LHCSA) is a private company that offers custodial care. A LHCSA is regulated by the state and provides hourly personal care services through home health attendants with oversight by a nurse. A nurse and social worker first develop a care plan for the client then assign a home health aide to assist the client with daily activity like bathing and dressing. The aides can also perform light housekeeping, shopping, meal preparation, and laundry. They cannot provide any skilled care, handle medications, or provide medical treatment; only a nurse can perform medical tasks. LHCSAs are also known as Agencies or Providers.
Licensed Home Care Service Agencies: https://www.health.ny.gov/facilities/home_care/lhcsa/
Local Management Entity (LME) responsible for community-based, publicly funded mental health, intellectual and developmental disabilities, and substance use disorder services.
Local Management Entity/MCO: https://medicaid.ncdhhs.gov/providers/programs-and-services/behavioral-health-idd/lmemco-contracts-and-reports
Length of Stay (LOS) is a term to describe the duration of a single hospitalization episode. For example, the LOS for a Patient who is admitted on 3/1 and discharged on 3/4 is 3 days. (Admission Date-Discharge Date).
Long-Term Care (LTC) consists of services that help meet both the medical and non-medical needs of people with chronic illness or disability who cannot care for themselves for long periods of time. Although LTC may apply to people of any age, it is more commonly required by the senior citizen demographic.
LTC consists non-skilled services/care (such as assisting with normal daily tasks like dressing and using the bathroom) as well as Skilled or expert practitioners who provide a level of medical care to address multiple chronic conditions associated with older populations. LTC can be provided at home, in the community, in assisted living facilities or in nursing homes.
Long-Term Services and Supports (LTSS) are medical and/or personal care and supportive services needed by individuals who have lost some capacity to perform activities of daily living, such as bathing, dressing, eating, transfers, and toileting, and/or activities that are essential to daily living, such as housework, preparing meals, taking medications, shopping, and managing money.
A Managed Care Organization (MCO) is a health care group or organization of medical service providers who offers managed care health plans. Such organization contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products.
The Payer is the organization placing Patients with Providers. May be referred to as the Payer, Prepaid Health Plan (PHP), Contract, HHS, or State.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Managed care is a type of Medicaid delivery system. Under managed care, states sign contracts with “managed care organizations,” or MCOs, that provide medical services through their own networks of doctors and hospitals. The state pays the MCO a fixed annual fee for each Medicaid patient. The MCO takes responsibility for overseeing each person’s care.
More states are moving away from the traditional fee-for-service delivery system to managed care. In fee-for-service Medicaid plans, the state pays doctors and hospitals directly for each service provided.
Related: MCO, Medicaid.
Medicaid redetermination is the periodic process of reevaluating a patient’s eligibility for Medicaid, including their need for homecare services, to ensure they still meet the program’s criteria.
Medicaid Waivers are state specific Medicaid programs that allow for services to be provided outside of nursing homes. A very important distinction between nursing home Medicaid and Medicaid waivers is that nursing home Medicaid is considered an entitlement program, while waivers are not.
States seeking additional flexibility in design of their Medicaid programs may apply for formal waivers of some federal requirements. For example, certain eligibility and benefit provisions of the Medicaid statute may be waived to explore new approaches to the delivery of and payment for acute care and long-term services and supports (LTSS).
The national social insurance program in the United States, administered by the US Federal government since 1966. Medicare provides health insurance for Americans aged 65 or older who have worked paid into the system, regardless of income. Medicare also provides health insurance to younger people with disabilities, end stage renal disease and amyotrophic lateral sclerosis.
Managed Long–Term Care (MLTC) is a system that streamlines the delivery of long–term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. MLTCs are also known as Payers or Contracts in the HHAX system.
Managed Long–Term Care: https://www.health.ny.gov/health_care/managed_care/mltc/aboutmltc.htm
A list of doctors, healthcare Providers, and facilities (such as hospitals) from a health insurance plan from which insureds and dependents select their medical coverage. Medical Providers who are part of the health insurance plan (list) are considered “In-Network” while those who are not are “Out-of-Network”. Some benefit plans cover both In and Out of Network treatments/services. Others such as HMOs are limited, only covering In-Network services (unless care is obtained via an Emergency Room).
Non-Skilled services relate to caring for a patient’s basic needs and are usually provided by a non-licensed practitioner (which can include family members and neighbors, as well as an agency caregiver). Examples of non-skilled care include bathing, grooming, bathroom assistance, feeding, housekeeping, and running errands for a Patient.
Related: Skilled Services.
The National Provider Identifier (NPI) is a unique 10-digit identification number for covered health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.
NPI Frequently Asked Questions: https://nppes.cms.hhs.gov/webhelp/nppeshelp/NPPES%20FAQS.html
Also referred to as a Skilled Nursing Facility (SNF), provides 24-hour residential care provided by nursing Aides and Skilled nurses for people who have significant difficulty coping with daily living requirements and require continual nursing care (as determined by a local hospital social worker and their nursing facility Provider).
New York State Department of Health (NYS DOH) sets standards and regulates various types of Agencies that provide health or medical-related services to people in their homes.
New York State Department of Health: https://www.health.ny.gov/
The Home Care Registry provides limited information about home care workers who have successfully completed a state-approved training program in New York State. Information contained in the registry may be entered and updated by third parties, and the Department of Health does not guarantee the accuracy of third-party information provided nor endorse any individual listed herein. Individuals listed on the registry may not be currently certified or may be unemployable, or the information related to those individuals may be outdated. It is the responsibility of those accessing the registry to verify the credentials, employability and competency of any individual listed in the registry.
View the Registry: https://apps.health.ny.gov/professionals/home_care/registry/home.action
The mission of the Office of Developmental Programs (ODP) is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice, and opportunity in their lives. The office seeks to continuously improve an effective system of accessible services and supports that are flexible, innovative, and person-centered.
Office of Developmental Programs: https://www.dhs.pa.gov/providers/Providers/Pages/Developmental-Programs.aspx
The Office of Long-Term Living (OLTL) provides guidance to Patients (across Pennsylvania) who need assistance with finding available services and supports, finding Providers or Caregivers, payment for services, or becoming a Provider of long-term living services.
https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/Long-Term-Care-Services.aspx
The Office of the Medicaid Inspector General (OMIG) promotes and protects the integrity of the Medicaid program in New York State.
OMIG Mission: To enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
Office of the Medicaid Inspector General: https://omig.ny.gov/
In an Open State Model (Open Model), states allow Providers to use their existing EVV system, or allow them to choose one that best meets their individual needs, so long as it meets state and federal EVV requirements.
Home Healthcare News: https://homehealthcarenews.com/2017/11/evv-provision-leaves-home-health-in-open-vs-closed-dilemma/
Related: Closed State Model.
PACE is a Medicare and Medicaid program that provides comprehensive medical and social services to older adults who wish to continue living in their communities rather than in nursing homes.
The Pennsylvania Association of Community Health Choices (PACHC) is the state’s primary care association, representing and supporting the largest network of primary health care providers in the state of Pennsylvania.
PACHC: https://www.dhs.pa.gov/healthchoices/Pages/HealthChoices.aspx
The Patient is the person receiving services. May be referred to as Member, Client, Consumer, Participant, or Recipient.
Payers are organizations that set healthcare and homecare service rates, collect payments, process claims, and pay provider claims. Payers can be government authorities such as State Medicaid or the Veterans Health Administration, or private businesses such as Managed Care Organizations. Payers are usually different from providers. Providers are usually the ones offering the services, like hospitals or clinics.
North Carolina Prepaid Health Plans (PHPs) receive a monthly payment for each of their patients and contract with providers to deliver health services to their members.
https://files.nc.gov/ncdhhs/documents/PHPs-in-Medicaid-Managed-Care-PolicyPaper_revFINAL_20180516.pdf (PDF)
Related: LME (NC).
A personalized document outlining the specific healthcare services, treatments, and goals for a patient receiving homecare. It serves as a guide for care providers.
PPE includes items like masks, gloves, gowns, and face shields used by homecare providers to protect themselves and their patients from the spread of infections, such as during the COVID-19 pandemic.
A Preferred Provider Organization (PPO) is a managed care organization of medical doctors, hospitals, and other healthcare Providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients.
Private pay in the homecare industry refers to patients or their families directly paying for homecare services out of pocket, without relying on insurance or government programs.
In the Medicaid context, providers are people, businesses or government entities that are authorized to provide Medicaid services, such as homecare, to Medicaid recipients.
Refers to more than one admission into a medical facility for the same reason/treatment that a Patient was originally admitted for.
Referrals allow healthcare providers or other professionals to connect patients with specific homecare services or agencies based on their needs.
Remote Patient Monitoring involves the use of electronic tools or devices that record patients’ personal health and medical data.(e.g., vital signs, blood glucose, blood pressure etc.) remotely. In homecare, it allows healthcare providers to track patients’ conditions and provide timely interventions without the need for frequent in-person visits.
Representative refers to an unpaid person appointed by the self-direction participant to assist in directing services; may also be known as surrogate or designee.
Revenue Codes are descriptions and dollar amounts charged for hospital services provided to a patient. The revenue code tells an insurance company whether the procedure was performed in the emergency room, operating room, or another department. A valid procedure code (HCPCS or CPT-4) must be accompanied by a revenue code for it to be accepted by the insurance provider.
Revenue Codes: https://valuehealthcareservices.com/education/understanding-hospital-revenue-codes/
Social Determinants of Health (SDOH) are the non-medical factors that can influence the health of individuals and societies. They include elements like income, access to healthcare, job security, education, and housing.
Self-direction, consumer direction, and participant direction all refer to the participant having authentic choice and control over services and supports. The movement, the philosophy, the model, and the program are called “self-direction”. The services are “self-directed”.
Secure File Transfer Protocol (SFTP) is a secure version of File Transfer Protocol (FTP), which facilitates data access and data transfer over a Secure Shell (SSH) data stream. It is part of the SSH Protocol. This term is also known as SSH File Transfer Protocol. SFTP is used daily at HHAeXchange to receive (import) and send (export) large client files. For example, the HHAX system allows for importing Patient Schedules, Authorizations, and Remittances from Payers’ systems; and, exporting several file types, such as Patients, Caregivers, Visits, Billing, and Payroll.
Note: Key Difference: FTP and SFTP are two different file transfer protocols and the major difference between the two is the security associated with the file transfer. FTP was the first file protocol and is less secure, while SFTP stands for secure file transfer protocol, and as the name suggests is more secure than FTP.
Related: EDI, FTP.
Skilled services are typically provided by medical professionals and licensed practitioners (such as Registered Nurses, Physical Therapists, etc.).
Examples of skilled nursing care include: injections (and teaching patients to self inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care.
Related: Non-Skilled Services.
In the self-direction context, the spending plan specifies how the allocated amount or individual budget will be used. Will staff be hired? Will goods and services be purchased?
Support Broker refers to a person who assists the self-direction participant in developing and carrying out his/her plan. Also called Support Planner, Service Coordinator, Support Coordinator, or Counselor. Depending on the jurisdiction, support brokerage tasks may be performed by staff employed by provider agencies, public employees of state, county, or local governments, or by independent professionals.
A Taxpayer Identification Number (TIN) is an identification number used by the Internal Revenue Service (IRS) in the administration of tax laws. It is issued either by the Social Security Administration (SSA) or by the IRS. A Social Security number (SSN) is issued by the SSA whereas all other TINs are issued by the IRS.
PPD, TB Screen, and QuantiFERON tests are used to test if someone is infected with Tuberculosis (TB). PPD and TB Screen are interchangeable terms that represent the same type of TB testing, while QuantiFERON is a more expensive and accurate test. If test results are:
All U.S. health care personnel should be screened for TB upon hire at an Agency. The local health department should be notified immediately if TB disease is suspected. Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission.
The UB-04 (CMS 1450) uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims.
Although developed by the Centers for Medicare and Medicaid (CMS), the form has become the standard form used by all insurance carriers. The UB-04 claim form is used by hospitals, nursing facilities, In-Patient, and other facility Providers. The HCFA-1500 (CMS 1500) medical claim form is employed by individual doctors and practices, nurses, and professionals, including therapists, chiropractors, and Out-Patient clinics.
UB-04: https://www.cms.gov/medicare/coding-billing/electronic-billing/institutional-paper-claim-form
In HHAeXchange the Universal Patient Record (UPR) is a functionality enabled for Linked contracts to enable the Provider to edit specific fields on the patient profile otherwise governed by the Payer.
Unlike traditional fee-for-service models, value-based care models offer financial incentives for delivering high quality care, so providers earn more when patients achieve better outcomes.
National and state-specific lists providing verification that a healthcare Provider is credentialed to practice indicated skills (e.g., verifying a practitioner’s NPI). Related: NPI.
The Veterans Administration (VA) is a U.S. government agency responsible for providing healthcare services, including homecare, to eligible veterans. VA homecare services can include home health, palliative care, and long-term care.
The Visiting Nurse Service of New York (VNSNY) is the largest and one of the oldest not-for-profit home healthcare Agencies in the United States. VNSNY has nearly 17,000 Employees to include: 1,602 Nurses (averaging 13 years of field experience), 525 Rehabilitation Therapists, 11,718 certified Home Health Aides, 414 Social Workers, and 139 other Clinical Professionals.
A Verification Organization (VO) is an entity operating in manner consistent with applicable federal and state confidentiality and privacy laws and regulations, using electronic means to include telephone verification or verified electronic data to verify whether a service or item was provided to an eligible Medicaid Recipient. In the HHAX system, the main method of verification is Electronic Visit Verification (EVV) and Point of Service (POS) Data Capture (gather information that occurred at the POS; the Medicaid Recipient’s home).
The data captured includes the Recipient’s identity, the Caregiver’s identity, the Date, Time, Duration, Location, and the Type of Service being delivered. This critical information is captured via telephony or GPS to ensure the presence of the Caregiver at the Patient’s home.
In Medicaid, most self-direction is funded under a “waiver.” Medicaid waiver programs provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. Prior to 1991, the Federal Medicaid program paid for services only if a person lived in an institution.
Worker, in the self-direction context, is someone chosen by the individual to provide direct personal assistance; this may include friends and family. Also referred to as an employee, direct care worker, direct support professional, independent provider and more. Related: Self-Direction.