Medical Records and the Law

552 APPENDIX A: ACRONYMS AND DEFINITIONSLocal codesLong consent formManaged careMaximum defined data setMCOMedical code setsor otherwise unable to make decisions personally.A generic term for code values that are definedfor a state or other local division orfor a specific payer. Commonly used to describeHCPCS Level III Codes.*A form with a detailed description of a patient’smedical condition, proposed procedure,consequences, risks, and alternativesto treatment. Also called a detail or specialconsent form.Any method of healthcare delivery designedto reduce unnecessary utilization of servicesand provide for cost containment while ensuringthat high quality of care or performanceis maintained; a system to minimizecost of care and “churning” while still deliveringgood access to high-quality healthcare; arrangements made by payers to promotecost-effective health care through establishingselective relationships withhealthcare providers, developing coordinatedor integrated delivery systems, andconducting medical management activities.Under HIPAA, this is all of the requireddata elements for a particular standardbased on a specific implementation specification.An entity creating a transaction isfree to include whatever data any receivermight want or need. The recipient is free toignore any portion of the data that is notneeded in order to conduct their part of theassociated business transaction, unless thenonessential data are needed for coordinationof benefits.*Managed care organizationCodes that characterize a medical conditionor treatment. These code sets are usuallymaintained by professional societies andpublic health organizations. Compare toadministrative code sets.*