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CCMC Certification
AAPM&R -
American Academy of Physical Medicine and Rehabilitation Access to Care - The ability and ease of clients to obtain healthcare when they need it. Accessible - A term used to denote building facilities that are barrier-free thus enabling all members of society safe access, including persons with physical disabilities. Accountable Care Organization (ACO) - A set of healthcare providers including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients. ACO's became popular in the Medicare fee-for-service benefit system as a result of the Affordable Care Act. Accreditation - A standardized program for evaluating healthcare organizations to ensure a specified level of quality, as defined by a set of national industry standards. Organizations that meet accreditation standards receive an official authorization or approval of their services. Accreditation entails a voluntary survey process that assesses the extent of a healthcare organization's compliance with the standards for the purpose of improving the systems and processes of care (performance) and, in so doing, improving client outcomes. Actionable Tort - A legal duty, imposed by statute or otherwise, owing by defendant to the one injured. Active Listening - A structured way of communication and interacting in which one is actively engaged with the speaker primarily through focused attention and suspension of one's own frame of reference, biases, distractions and judgment. A communication technique that improves personal relationships, fosters understanding, and facilitates cooperation and collaboration and eliminates conflict. Activities of Daily Living (ADLs) - Routine activities an individual tends to do every day for self-care and normal living. These include eating, bathing, grooming, dressing, toileting, transferring (such as walking, bed to chair) and continence. Assessment of an individual's ability to perform these ADLs is important for determining an individual's ability, independence, disability or limitations. This assessment determines the type of long-term care and benefit coverage the individual needs. care may include
placement in a nursing home, skilled care facility or home care services.Benefit coverage may include Medicare, Medicaid or long-term care insurance. Activity Limitations - Difficulties an individual may have in executing activities. An activity limitation may range from a slight to a severe deviation in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition. Actual Value - Also referred to as real value. Measures the worth one derives from using or consuming a good, product, service or an item, and represents the utility of the good, product, service, or item. Actuarial Study - Statistical analysis of a population based on its utilization of healthcare services and demographic trends of the population. Results used to estimate healthcare plan premiums or costs. Actuary - A trained insurance professional who specializes in determining policy rates, calculating premiums, and conducting statistical studies Acuity - Complexity and severity of the client's health/medical condition. Acute Care - The acute care delivery systems focus on treating sudden and acute episodes of illness such as medical and surgical management or emergency treatment, which otherwise cannot be taken care of in a less intense care setting. Acute care settings may include hospitals, acute rehabilitation centers, emergency care, transitional hospitals, and follow-up long-term disease management settings. ADA - Americans with Disabilities Act ADA Amendments Act - Americans with Disabilities Act Amendments Act of 2008 ADL - Activities of Daily Living. Routine activities carried out for personal hygiene and health and for operating a household. ADLs include feeding, bathing, showering, dressing, getting in or out of bed or a chair, and using the toilet. Adaptive Behavior - The effectiveness and degree to which an individual meets standards of self-sufficiency and social responsibility for his/her age-related cultural group. Adherence - "The extent to which a person's behaviour--taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations
Any untoward occurrences, which under most conditions are not natural consequences of the client's disease process or treatment outcomes. Advocacy - The act of recommending, pleading the cause of another; to speak or write in favor of. (CMSA Standards of Practice, 2010, p 24). Advocate - A person or agency who speaks on behalf of others and promotes their cause. Affect - The observable emotional condition of an individual at any given time. Affidavit - A written statement of fact signed and sworn before a person authorized to administer an oath. Aggregated Diagnosis Groups (ADGs) - A grouping of diagnosis codes that are similar in terms of severity and likelihood of persistence in a client's health condition over time. An individual client can suffer more than one health condition and therefore may have more than one ADG (total of 32 ADG clusters). Individual diseases or conditions are placed into a single ADG based on a set of criteria including likely persistence of diagnosis, severity of illness, etiology, diagnostic certainty, and need for specialty care interventions. This system was developed by the Bloomberg School of Public Health at Johns Hopkins University. Aggregated Medical Examination - An evaluation conducted by a provider who is selected by agreement between an injured workers' attorney and the insurance claims administrator and/or attorney. The parties agree to conduct a medical examination and prepare a medical- legal report to help resolve an existing dispute. The evaluation also serves to determine what portions of the work-related injury have contributed to the disability and what portions have resulted from other sources or causation AHA - American Heart Association AHRQ - Agency for Healthcare Research and Quality Algorithm - The chronological delineation of the steps in, or activities of, client care to be applied in the care of clients as they relate to specific conditions/situations. Alternate Level of Care - A level of care that can safely be used in place of the current level and determined based on the acuity and complexity of the client's condition and the type of needed services and resources. AMA - American Medical Association
Ambulatory Payment Classification (APC) System - An encounter-based classification system for outpatient reimbursement, including hospital-based clinics, emergency departments, observation, and ambulatory surgery. Payment rates are based on categories of services that are similar in cost and resource utilization. ANA - American Nurses Association ANCC - American Nurses Credentialing Center Ancillary Services - Other diagnostic and therapeutic services that may be involved in the care of clients other than nursing or medicine. Includes respiratory, laboratory, radiology, nutrition, physical and occupational therapy, and pastoral services. APC - Ambulatory Payment Classification Appeal (Care Provision Related) - The formal process or request to reconsider a decision made not to approve an admission or healthcare services, reimbursement for services rendered, or a client's request for postponing the discharge date and extending the length of stay. Appeal (Legal in Nature) - The process whereby a court of appeals reviews the record of written materials from a trial court proceeding to determine if errors were made that might lead to a reversal of the trial court's decision Appropriateness of Setting - Used to determine if the level of care needed is being delivered in the most appropriate and cost- effective setting possible. Approval - To offer or receive affirmation, sanction, or agreement about a decision, action, service, treatment, or intervention. In the area of health insurance, it is the act of authorizing or affirming a service to a client that implies agreement to be responsible for reimbursing the provider of the service the related cost of providing the service to a client/support system Approved Charge - The amount Medicare pays a physician based on the Medicare fee schedule. Physicians may bill the beneficiaries for an additional amount, subject to the limiting charge allowed. ASO - Administrative Services Only Assessing -
A physical, manmade environment or arrangement of structures that is safe and accessible to persons with disabilities Barriers - Factors in a person's environment that, if absent or present, limit one's functioning and create disability. Examples are a physical environment that is inaccessible, lack of relevant assistive technology, and negative attitudes of people toward disability. Barriers also include services, systems, and policies that are either nonexistent or that hinder the involvement of people with a health condition in any area of life. BAS - Burden Assessment Scale Benchmarking - An act of comparing a work process with that of the best competitor. Through this process one is able to identify what performance measure levels must be surpassed. Benchmarking assists an organization in assessing its strengths and weaknesses and in finding and implementing best practices. Beneficence - Compassion; taking positive action to help others; desire to do good; core principle of client advocacy. Beneficiary - An individual eligible for benefits under a particular plan. In managed care organizations beneficiaries may also be known as members in HMO plans or enrollees in PPO plans. Benefit Package - The sum of services for which a health plan, government agency, or employer contracts to provide. In addition to basic physician and hospital services, some plans also cover prescriptions, dental, and vision care. Benefit Programs - Government agency, or employer to individuals based on some sort of an agreement between the parties; for example between an employer and an employee. Benefits vary based on the plan and may include physician and hospital services, prescriptions, dental and vision care, workers' compensation, long-term care, mental and behavioral health, disability and accidental death, counseling and other therapies such as chiropractor care. Benefits - Principal Term: The type of health and human services covered by an insurance company/health plan and as agreed upon between the plan/insurance company and the individual enrollee or participant. Benefits also refers to the amount payable by an insurance company to a claimant or beneficiary under the claimant's specific coverage as stipulated in the agreed upon health plan. Beyond (Outside) - the - Walls Case Management -
Models where healthcare resources, services and case managers are based externally to an acute care/hospital setting, that is in the community. Board Certified Case Manager - A case manager who has earned the certified case manager (CCM) credential offered by the Commission for Case Manager Certification (CCMC). This involves passing an evidence-based certification examination after meeting a set of criteria that qualifies the case manager to sit for the examination. Once certified, the case manager must maintain the certification by acquiring ongoing education through means of continuing education units (CEUs), and uphold the CCM Code of Professional Conduct for Case Managers. Body of Knowledge (BOK) - Widely recognized information, standards, methods, tools, and practices about a specific field. A BOK usually includes a comprehensive set of concepts, terms, tools, and activities that make up a profession, as defined by a relevant professional society. While the term body of knowledge is used to describe the document that defines that knowledge, the body of knowledge itself is a dynamic reference that "is more than simply a collection of terms and concepts; a professional reading list; a library; a website or a collection of websites; a description of professional functions; or even a collection of information" (Wikipedia, 2010). Therefore, one may then describe a BOK as a prescribed aggregation of essential knowledge in a particular field or specialty an individual within the field is expected to have mastered to effectively practice and be considered a practitioner within the specialty (Babylon Online Dictionary, 2009). BOK - Body of Knowledge Bona Fide - "In Good Faith" Brain Disorder - A loosely used term for a neurological disorder or syndrome indicating impairment or injury to brain tissue. Brain Injury - Any damage to tissues of the brain that leads to impairment of the function of the Central Nervous System. Burden of Proof - The duty of producing evidence as the case progresses, and/or the duty to establish the truth of the claim by a preponderance of the evidence. The former may pass from party to party, the later rests throughout upon the party asserting the affirmative of the issue. Capacity - A construct that indicates the highest probable level of functioning a person may reach. Capacity is measured in a uniform or standard environment, and thus reflects the environmentally adjusted ability of the individual.
The person responsible for caring for a client in the home setting. Can be a family member, friend, volunteer, or an assigned healthcare professional. CARF - Commission on Accreditation of Rehabilitation Facilities. A private, non-profit organization that establishes standards of quality for services to people with disabilities and offers voluntary accreditation for rehabilitation facilities based on a set of nationally recognized standards. Carpal Tunnel Syndrome - The name given to the symptoms that occur when the nerves and tendons running through the carpal tunnel of the wrist are compressed by tissue or bone or become irritated and swell.The carpal tunnel itself is a narrow passage in the wrist comprised of bones and ligaments through which nerves and tendons pass into the hand. Also referred to as "Cumulative Trauma Injury/Disorder," "Repetitive Motion Injury," and "Repetitive Stress Syndrome." Carrier - The insurance company or the one who agrees to pay the losses. A carrier may be organized as a company, either stock, mutual, or reciprocal, or as an Association or Underwriters. Carve Out - Services excluded from a provider contract that may be covered through arrangements with other providers. Providers are not financially responsible for services carved out of their contract. Case-Based Review - The process of evaluating the quality and appropriateness of care based on the review of individual medical records to determine whether the care delivered is acceptable. It is performed by healthcare professionals assigned by the hospital or an outside agency (e.g., Peer Review Organization [PRO]). Case Closure - Terminating the provision of case management services to aclient/support system. The process of communicating the decision to terminate services to clients/support systems, payor representative, and other healthcare professional involved. Case Conference - A multidisciplinary healthcare team meeting that is held to discuss a client or client's support system situation such as conflict in decision making between the client and client's support system, clarification of plan of care and prognosis, end of life issues, or an ethical dilemma. Depending on the purpose of the conference, the client and client's support system may or may not participate in the meeting. Other participants are the case manager, social worker, physician of record or primary care provider, specialty care provider, registered nurse, registered dietitian, physical therapist, occupational therapist, ethicist (if the purpose is an ethical dilemma) and others as necessary. Case Law - The aggregate of reported cases forming a body of jurisprudence, or the law of a particular subject as evidenced or formed by the adjudged cases, in distinction to statutes and other sources of law.
Case Management - "A collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet the client's health and human services needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes" (CCMC, 2010). Case Management Body of Knowledge (CMBOK) - A comprehensive resource of essential knowledge in the field of case management that a case manager is expected to master and become knowledgeable, skilled, as well as experienced in, to effectively care for clients and their support systems and be considered a competent case management practitioner. Case Management Department - A division within a healthcare organization (e.g., provider, employer, or payor) responsible for the provision of case management services to clients and their support systems. Case Management Model - A conceptual or graphic representation of the practice of case management in an organization. It usually depicts the relationships among the key functions and stakeholders of case management, and the roles and responsibilities of case managers. Case Management Plan - A timeline of patient care activities and expected outcomes of care that address the plan of care of each discipline involved in the care of a particular patient. It is usually developed prospectively by an interdisciplinary healthcare team in relation to a patient's diagnosis, health problem, or surgical procedure.
