A medical procedure in which a whole or partial organ is moved from one body to another for the purpose of replacing the recipient’s damaged or failing organ with a healthy organ from a donor. Organ transplants can be categorized as life-saving, while tissue transplants are life-enhancing. Organs that can be transplanted include the heart, kidneys, liver, lungs, pancreas and intestine. Tissues that can be transplanted include bones, tendons, cornea, heart valves, veins and skin.
This category encompasses any issues and difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate time, excessive total sleep time or abnormal behaviors associated with sleep. Although more than 100 different sleep disorders have been identified, they can be grouped into four categories: problems with falling and staying asleep; problems staying awake; problems with adhering to a regular sleep schedule and sleep-disruptive behaviors. Common sleep disorders include insomnia, sleep apnea, narcolepsy, restless leg syndrome, sleep walking and sleep terror disorder.
The branch of medicine concerned with creating diagnostic images of anatomic structures through the use of electromagnetic radiation or sound waves. This branch of medicine treats disease through the use of radioactive compounds. Radiological imaging techniques include x-rays, CAT scans, PET scans, MRIs and ultrasonograms.
The branch of medicine concerned with the study, treatment and prevention of mental disorders. Within psychiatry, eight specialty branches exist, including biological, community, descriptive, dynamic, forensic, geriatric, preventive and social.
The branch of medicine concerned with the functional restoration of a person affected by a physical disability. Physical medicine involves the management of disorders that alter the function and the performance of a patient with emphasis placed upon the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipments and assistive device, orthotics, prosthesis and experimental training approaches.
The branch of gastroenterology concerned with the health and care of the stomachs, intestines and related organs of the gastrointestinal tracts of children.
A medical procedure, also known as neurosurgery, that encompasses any surgery performed on the nervous system, including the brain, spinal cord or peripheral nerves.
A surgical procedure used to implant a healthy kidney into a patient with kidney failure. Also called a renal transplant, kidney transplants are recommended for patients with kidney failure caused by severe high blood pressure, infections, diabetes and glomerulonephritis. Kidney transplants are not recommended for patients with heart, lung or liver disease, certain infections like TB or osteomyelitis or who would have difficulty taking medications several times daily for the rest of their lives.
A surgical procedure used to remove a damaged or diseased heart and replace it with a healthy donor heart. Also called a cardiac transplant, heart transplants are recommended for patients who experience heart failure caused by coronary heart disease, cardiomyopathy, heart valve disease with congestive heart failure, severe heart disease present at birth, and life-threatening abnormal heartbeats that do not respond to other therapy. Heart transplant surgery is not recommended for patients who have kidney, lung or liver disease, insulin-dependent diabetes, other types of blood vessel disease of the neck and leg, or other life-threatening diseases.
A specialty that concentrates on the abdominal organs, including the intestines, esophagus, stomach, colon, liver, gallbladder, bile ducts, hernias and the thyroid gland.
The branch of medicine concerned with the glands and hormones and their related disorders. Common endocrine disorders include disorders or diseases of the thyroid, parathyroid, adrenal gland, pituitary gland, gonads and pancreas.
The branch of radiology concerned with medical imaging. Medical imaging modalities include radiography, CT scanning, sonography, magnetic resonance imaging (MRI) and nuclear medicine.
A form of diagnosing and treating illnesses that affect the nerves, bones and joints of the body. At the core of chiropractic practice is the belief that all illnesses are a result of abnormal nerve transmission caused by "vertebral subluxation" or spinal misalignment.
Brachytherapy, or the interstitial implantation of radioactive seeds, is an option for treatment of prostate cancer. The treatment is considered alternative or complement to external beam radiotherapy. During the procedure, the radioactive seeds are implanted permanently, using the transperineal route, as a potentially curative treatment for localized prostate cancer. The procedure is intended to deliver tumoricidial radioactivity directly to the tumor and improve local control while sparing surrounding tissue. The surgery can be done as an outpatient procedure.
Impairment of conduction of cardiac impulses from the atria to the ventricles, usually due to a block in the atrioventricular junctional tissue (atrioventricular node, bundle of His, or bundle branches). It is generally subclassified as first, second or third degree atrioventricular block.
The evaluation process of the appropriateness, medical necessity and efficiency of healthcare services, procedures and facilities, according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically, utilization review includes new activities or decision based upon analysis of a case. It describes proactive procedures including discharge planning, concurrent planning an appeals introduced by a provider, payer or patient.
The MCO committee that reviews and updates the MCO’s utilization management, program establishes utilization review protocols, reviews referral and utilization patterns, and reviews utilization decisions for medical appropriateness.
A coding inconsistency that involves using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that result in higher reimbursement to the provider
The process of selecting, classifying, analyzing and assuming risk, according to insurability. Underwriting is the insurance function bearing the risk of adverse price fluctuations during a particular period. Underwriting results in the analysis of a group that is done to determine rates or to determine whether the group should be offered coverage at all.
An organization that processes health care claims without carrying insurance risk. TPAs are prominent players in the managed care industry and have the expertise and capability to administer all, or a portion of, the claims process. They are normally contracted by a health insurer or self-insuring companies to administer services, including claims administration, premium collection, enrollment and other administrative activities. While some TPAs may operate as units of insurance companies, they are often independent. However, hospitals or provider organizations desiring to set up their own health plans will often outsource certain responsibilities to TPAs.
A monoclonal antibody used to prevent viral respiratory tract infections in infants and young children at risk for infection. It works by preventing the growth of RSV. Synagis is ideal for babies born prematurely at 35 weeks or less, with heart disease or with chronic lung disease.
A type of insurance coverage that enables provider organizations or self-funded groups to place a dollar limit on their liability for paying claims and requires the insurer issuing the insurance to reimburse the insured organization for claims paid in excess of a specified yearly maximum.
The Self-Insurance Institute of America is the only national association dedicated exclusively to protecting and promoting self-insurance and alternative risk transfer industry. Founded in 1981, the association includes members such as self-insured employers, group self-insured Workers’ Compensation funds, third-party administrators, managing general underwriters, excess/stop-loss insurance carriers and a variety of other self-insurance/alternative risk transfer businesses.
The precise removal of diseased sinus tissue with the improvement in the natural drainage channels by the creation of a pathway for infected material to drain from the sinus cavities. Surgery is often used for sinusitis to unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis. Three types of sinus surgery include functional endoscopic sinus surgery, balloon sinuplasty and invasive conventional treatment.
