Dictionary

The following terms are used throughout CompareMaine.

  • Agency for Healthcare Research and Quality (AHRQ)

    The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable. AHRQ is a part of the U.S. Department of Health and Human Services. It is a source of data on health quality for CompareMaine. Learn more at AHRQ

  • Ambulatory Payment Classification (APC)

    The United States government's method for paying for facility outpatient services for the Medicare program.

  • Average Total Payment

    The average dollar amount the insurance company and the insured individual pay a healthcare provider and/or setting for a healthcare service or procedure. The average is calculated using the median, which is the middle dollar amount in a range of numbers from lowest to highest. The average total payment does not represent actual payments, as that amount varies based on individual circumstances.

  • Bundled Service

    A service with an estimated payment that includes other related procedures. For example, a bloodwork procedure that includes the cost to draw and transport the sample.

  • Clostridioides difficile (C. diff)

    Clostridioides difficile, is a bacteria that causes diarrhea, fever, loss of appetite, nausea and belly pain. Patients are at higher risk of getting sick from C.diff if they are taking antibiotics, have recently stayed in a hospital or nursing home, are 65 years or older or have weakened immune systems. CompareMaine uses this for the Preventing Healthcare-Associated Infections quality measure.

  • Centers for Medicare & Medicaid Services (CMS)

    Centers for Medicare & Medicaid Services is a U.S. Federal Agency that administers Medicare, Medicaid, and the State Children’s Health Insurance Program. CMS is a source of data on cost and quality for CompareMaine. Learn more at CMS

  • Confidence Interval

    Expresses the degree of uncertainty of an estimate and helps decide how precise the estimate is. The mean, plus and minus a margin of error in that estimate, is used to calculate the confidence interval. For example, CompareMaine uses a 95% confidence interval, meaning 95% of the time, the true value is represented in the estimate and 5% of the time, the value would not be represented.

  • Common Procedural Terminology (CPT) Code

    A five-digit code used by healthcare providers and settings to identify healthcare services and procedures. CPT Codes distinguish procedures from one another, such as a CT of abdomen with dye (CPT Code 74160) and a CT of abdomen without dye (CPT Code 74150). To get an accurate average payment, ask your healthcare provider for the CPT Code for your service or procedure. See the Services and Procedures page for a complete list of services and procedures reported on CompareMaine and their associated CPT Codes.

  • Diagnosis Related Groups (DRG)

    System used to categorize inpatient hospital services to standardize payments.

  • Discount-Off Charges

    An agreed upon rate for service between the healthcare provider and insurance company that is usually less than the provider’s full charge. This may be a fixed amount per service, or a percentage discount.

  • Distance to Healthcare Setting

    The estimated distance from the zip code you entered to the lead healthcare setting.

  • ETG Base

    The ETG Base class is a six-character code assigned to bundled episodes with Optum’s Symmetry® Episode Treatment Groups®. These codes have two components: a condition (indicated by the first four characters) and a body location (indicated by the last two).

  • HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)

    These are surveys that hospitals give to adult patients 48 hours to 6 weeks after the patient leaves the hospital. These survey ratings are the data source for patient experience, as reported on CompareMaine, and reflect how satisfied patients are with their hospital experience and the overall quality of care received. Learn more at HCAHPS

  • Healthcare Setting

    The term healthcare setting refers to several places where healthcare occurs, including hospitals, surgical centers, diagnostic imaging centers, health centers, laboratories, and clinics.

  • Hospital Quality Rating

    The rating indicates how well the hospital performs on measures of quality.

  • Healthcare Transparency

    The availability of information to the public on the cost and quality of specific healthcare services and procedures. Transparency is essential for people to make informed decisions about their care, for healthcare providers to evaluate their performance compared to others, and for health insurance companies and policymakers to identify and reward quality and efficiency.

  • Insurance Company

    Health insurance is a way to pay for care. "Show all insurance companies" shows the average payments across all insurance companies in Maine for the healthcare service or procedure at a healthcare setting. Average payments specific to one of Maine’s five major insurance companies is also available. All plans (e.g., HMO and PPO) are reported for each insurance company.

  • Lead Healthcare Setting

    The primary healthcare setting where a patient’s healthcare procedures are received. For example, a patient might be seen at her doctor’s office and have blood work done at another location. The lead healthcare setting would be the doctor’s office. See the Find a Healthcare Setting page for a list of all healthcare settings that report cost data.

  • Location

    A city or zip code can be used to locate healthcare settings. Search results are displayed alphabetically by the lead healthcare setting's name. If a healthcare setting has more than one location, the "Multiple locations" link under the setting’s address may contain the matching search results.

  • Maine State Average (Cost)

    The average payment across all healthcare settings in Maine for a procedure.

  • Maine State Average (Quality)

    The average rating across participating hospitals in Maine for a quality measure.

  • Methicillin-resistant Staphylococcus aureus (MRSA)

    Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that can cause serious infections in the body and can be difficult to treat because it is resistant to some antibiotics.

  • National Average

    The average rating across participating hospitals in the nation for the specific quality measure.

  • Number of Procedures or Services

    The number of procedures used to calculate the payment estimate at a healthcare setting.

  • Patient Experience

    These survey ratings from patients reflect how satisfied they are with their hospital experience and the overall quality of care received.

  • Payor-Based Fee-Schedules

    A fee schedule that lists the maximum payment an insurance company will allow for specific services.

  • Preventing Healthcare-Associated Infections (HAIs)

    Infections that patients get during treatment for other conditions in a healthcare setting. Hospitals can often prevent these complications by following established best practices. Preventing HAIs is an important way of measuring the quality of patient care.

  • Preventing Serious Complications

    These are harmful but preventable outcomes of healthcare or surgery in a hospital setting. The measure a combination of ten Patient Safety Indicators from the Agency for Healthcare Research & Quality (AHRQ) and shows how likely patients will suffer from complications while in the hospital or after having certain inpatient surgical procedures. Hospitals can often prevent these complications by following established best practices. Preventing serious complications is an important way of measuring the quality of patient care.

  • Professional

    An individual healthcare provider, such as a doctor, who provides direct services or procedures to a patient.

  • Professional Component

    The portion of the payment that covers expenses associated with the services provided by physicians, suppliers, and non-institutional providers. This component comes from a CMS 1500 claim form, which is used to submit billing information for healthcare services or procedures provided. The professional component may also be referred to as a professional fee.

  • Revenue Code

    A three- or four-digit code used on hospital bills to identify different types of services and supplies used, and the department where the services were provided to the patient.

  • Technical Component

    The portion of the payment that covers expenses associated with items like the use of the facility, equipment, supplies, and non-physician medical staff. This component may come from a UB-04 claim form or a CMS 1500 with a technical modifier, both of which are used to submit billing information for healthcare services or procedures provided. The technical component may also be referred to as a facility fee.

  • What makes up this payment?

    The average dollar amount the insurance company and the insured individual pay a healthcare provider and/or setting for a healthcare service or procedure. When more than one healthcare setting provides care, all costs are attributed to the setting with the largest portion of the payment.