Glossary

ACSC stands for Ambulatory Care Sensitive Conditions. ACSC conditions are medical conditions for which physicians broadly concur that a substantial proportion of cases should not advance to the point were hospitalization is needed if they are treated in a timely fashion with adequate primary care and managed properly on an outpatient basis.

All types of health services that do not require an overnight hospital stay.

A land vehicle specifically designed, equipped, and staffed for life saving and transporting the sick or injured.

An air or water vehicle specifically designed, equipped, and staffed for life saving and transporting the sick or injured.

Individual charge determined by a carrier for a covered SMI medical service or supply.

Is a rule or procedure containing conditional logic for solving a problem or accomplishing a task. Guideline algorithms concern rules for evaluating patient care against published guidelines. Criteria algorithms concern rules for evaluating criteria compliance. Algorithms may be expresses in written form, graphic outlines, diagrams, flow charts that describe each step in the work or thought process.

One of a class of simple proteins in the blood. The level of albumin may reflect the amount of protein intake in food.

An individual aged 65 or over, who is enrolled in the SMI program.

A health care provider or facility that is paid by a health plan to give service to plan members.

A Medicare carrier, FI, or other contractor such as a Durable Medical Equipment Regional Carrier (DMERC), which shares some or all of the PSC's jurisdiction in which the affiliated contractor performs non-PSC Medicare functions such as claims processing or education.