Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 170Appendix C - DefinitionsVersion 3.0Medical Management Guideimprove outcomes. The Group Visit Starter Kit describes the Cooperative Health Care Clinic (CHCC) modeldeveloped by the Kaiser Colorado staff. Group visits were pioneered with frail elderly patients who were highutilizers of primary care.In this model, the healthcare team facilitates an interactive process of care delivery in a periodic group visitprogram. The team empowers the patient, who is supported by information and encouraged to make informedhealthcare decisions. The group visit can be conceptualized as an extended doctor's office visit where notonly physical and medical needs are met, but education, social, and psychological concerns can be dealt witheffectively.Resources:Institute for Healthcare Improvement: http://www.ihi.org/IHI/Topics/ChronicConditions/AllConditions/Tools/GroupVisitStartKit.htm.Improving Chronic Care:• http://www.improvingchroniccare.org/downloads/groupvisitmodelcomparison.pdf• http://www.improvingchroniccare.org/downloads/group_visit_starter_kit_copy1.docHealth PromotionAny combination of health information, education, diagnostic screening, and healthcare interventions designedto facilitate behavioral alterations that will improve or protect health. It includes those activities intended toinfluence and support individual lifestyle modification and self-care.MHS population health initiatives often follow guidance from Healthy People (e.g., Healthy People 2010).Resources:DoD Manual 6015.1-M, Glossary of Healthcare Terminology (January 1999): http://www.dtic.mil/whs/directives/corres/pdf/601501m.pdf.See CD-ROM Resource AppendixC-Def 1DoDD 1010.10, Health Promotion and Disease Injury Prevention (Aug. 22, 2003): http://www.dtic.mil/whs/directives/corres/pdf/101010p.pdf.Healthy People 2010: http://www.healthypeople.gov/.Health Insurance Portability and Accountability Act (of 1996) (HIPAA)A law that includes provisions for health insurance portability, fraud and abuse control, tax-related provisions,group health plan requirements, revenue offset provisions, and administrative simplification requirements.It addresses the use, disclosure, and security of private health information. It affects health care in terms ofpatient privacy and confidentiality. The HIPAA Privacy Rule establishes national standards to protect individuals’medical records and other personal health information and applies to health plans, healthcare clearinghouses,and those healthcare providers that conduct certain healthcare transactions electronically. The Rule requiresappropriate safeguards to protect the privacy of personal health information (PHI) and sets limits and conditionson the uses and disclosures that may be made of such information without patient authorization. The Rule also
Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 171gives patients rights over their PHI, including the right to examine and obtain a copy of their health records andrequest corrections.Resources:TRICARE:• http://www.tricare.osd.mil/hipaa/faq_ans.htm• http://www.tricare.osd.mil/tmaprivacy/hipaa/hipaacompliance/images/pdf/Documentation_Jan03.pdfDepartment of Health and Human Services (HHS):• http://www.hhs.gov/ocr/hipaa/• http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/index.htmlInternational Classification of Diseases – 9th Revision – Clinical Modification (ICD-9-CM)The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on theWorld Health Organization's Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM is theofficial system of assigning codes to diagnoses and procedures associated with hospital utilization in the UnitedStates. The ICD-9 is used to code and classify mortality data from death certificates. The ICD-9-CM consists of:• A tabular list containing a numerical list of the disease code numbers in tabular form.• An alphabetical index to the disease entries.• A classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabularlist).Resources:Centers for Disease Control and Prevention (CDC) — Classifications of Diseases and Functioning andDisabilities: http://www.cdc.gov/nchs/about/otheract/icd9/abticd9.htm.Inter/Intraregional CareCare received in a region other than the region in which the beneficiary is enrolled, which includes bothcontinental U.S. and overseas locations.Intraregional care is care received within a region where a beneficiary is enrolled but outside their MTF’scatchment area. Care may be received from any branch of Service.Resources: N/ALight DutyTime spent performing “light duty” work does not count against an employee’s FMLA leave entitlement. Theemployee’s right to restoration is held in abeyance during the period of time the employee performs light duty(or until the end of the applicable 12-month FMLA leave year). An employee who is voluntarily performing alight duty assignment is not on FMLA leave.Presumes frequent provider/patient interaction to determine whether return to full duty status or moreintensive therapeutic intervention is appropriate in any given case; therefore, light duty will be ordered in
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Medical Management Guide, 2009, Version 3.0 - Tricare

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