Big changes in healthcare mean big changes in the way providers and payers talk. Many terms being bandied about don't have clear or solid meanings, but this guide helps sort things out.
This is the year the Patient Protection and Affordable Care Act will get into full swing. Healthcare providers are already creating their own jargon to convey some of the complex concepts behind the law.
Some of it is starting to sound familiar, but what it all means is not exactly clear.
To get ready for 2014's buzzwords, here's Part 1 of list of PPACA argot, insider idioms, and provider patois that just might help get you through the year.
1. High Outliers
Some 158 "high outlier" hospitals were singled out by the Office of Inspector General in a November report because on average, $1 out of every $8 they received from Medicare came in the form of outlier payments. For 13 of these hospitals, outlier payments amounted to more than $1 in $5, because the hospital received charges rather than what Medicare typically pays for a patient with that diagnosis.
The report said the disparity "raises concerns about why charges for similar patient-care cases vary substantially across hospitals," and called for "increased scrutiny" from the Centers for Medicare & Medicaid Services. CMS agreed.