Glossary of Terms

Accept Assignment:
Medical providers bill and receive payment directly from third-party payer. Under Medicare, the beneficiary is not required to pay any difference between actual charges and those charges deemed reasonable by Medicare when the provider accepts assignment. However, the beneficiary must still pay any deductible and co-insurance amounts due.

Advanced Life Support (ALS):
Includes the services of basic life support (BLS) and advanced emergency care.
ALS personnel provide: intravenous therapy, endotracheal intubation, PASG application (considering new protocols), cardiac monitoring (ECG), cardiac defibrillation and external pacing, drug therapy, relief of pneumothorax, and other invasive procedures and services.
Personnel who respond in either a transport-capable ambulance vehicle or in a non-transporting vehicle such as a fire department engine or separate response vehicle can provide ALS.
Non-transporting ALS responders are referred to as ALS first responders or ALS Quick Response Services (QRS).

Actual Charge: 
A charge made by an ambulance service for specific service at a specific time. 
(The actual charge may not reflect the customary charge.)

All-Inclusive Rate:
A flat fee charged for services rendered.

Allowable Charge:
A generic term referring to the fee that a third party will pay in reimbursing a provider for a given service.

Allowable Charge: 
Items or elements of a provider's costs that are reimbursable under payment formula.
Medicare, Medicaid and most Blue Cross plans reimburse providers for certain costs, but do not allow reimbursement for all costs.

Ambulance Patient:
Any person being transported to or from a health care facility in a reclining position from any point.

Ambulance Service Contract:
An agreement between a private contractor and any local governing unit incorporating clinical standards and financial provisions consistent with those set forth in a master contract.

Ambulance Service Contractor:
A private ambulance service.

ANI/ALI:
Automatic Number Identifier/Automatic Location Identifier, one of the enhancement features of the 911 system that aids in the identification and location of incoming calls.

Assignment of Benefits:
Written authorization by a patient permitting payment benefits directly to the provider. (See Accept Assignment)

Automatic Vehicle Locator (AVL):
A system used to exhibit the location of vehicles and/or assignments on a computerized mapping system.
AVL systems are often used by the communications center to identify and dispatch the closest appropriate EMS unit to the scene of an incident.

Average Response Time:
A response time calculation method in which all cumulative elapsed times are divided by the number of incidents to determine an average.

Bad Debts:
Amounts considered to be uncollectable from accounts and notes receivable that were created or acquired in providing services.

Basic Life Support (BLS):
The basic level of care provided by basic first responders and emergency medical technicians (EMTs).

Care includes: basic airway management, care of choking victims, oxygen administration, hemorrhage control, splinting fractures and immobilization of spinal injuries.

In some areas, BLS personnel are also certified to perform automatic external defibrillation (AED) - referred to as EMT-Ds.

CAD:
Computer-assisted dispatching including, but not limited to, primary dispatch data entry and automated time-stamping, 911 data interface, demand pattern analysis, system status management, automated patient locator aids, response time reporting and documentation, and (when installed) automatic vehicle tracking.
An SSM-based CAD is a CAD capable of handling on-line systems status management (SSM) controls and off-line SSM reporting required for on-going refinement of the system status plan (SSP).

Call Queuing:
Stacking of calls waiting to be processed.

Call Reception:
The process of answering the telephone and processing the information for the caller in an emergency dispatch center.

Call Screening:
A process in which requests for service are screened and either refused ALS service, referred to other providers or assigned to BLS units for response.

Co-Insurance:
Established percentages indicating the portion of covered expenses, beyond the deductible, to be paid under the portion to be borne by the subscriber (patient).

Communications Center:
The central point where emergency and non-emergency lines terminate and units are dispatched.

Sometimes referred to as the dispatch center or an Emergency Operations Center or EOC.

Contract Service Area:
The geographic area encompassing the Regulated Service Area as defined by the local government unit and such other cities or counties as may choose to contract with the provider. The services provided in this geographic area are subject to a contract incorporating clinical standards and financial provisions consistent with those contained in the Master Ambulance Service Contract.

Contractual Allowance:
An accounting adjustment to reflect the difference between charges for service rendered to insured persons and the amount paid for those services under contract with the third-party payer.

Co-Payment:
A type of health care cost-sharing in which the insured or covered person pays a fixed amount per unit of medical service or unit of time (e.g., $2 per physician visit, $10 per inpatient hospital day) and the insured pays the rest of the cost.
The co-payment is incurred at the time the service is used, and the amount paid does not vary with the cost of the service (unlike co-insurance, which is payment of some percentage of the cost).

Customary Charge:
Used interchangeably with the term usual charge and referring to that amount the provider normally and usually charges the majority of patients for a particular medical service.

Demand Analysis:
The deployment of ambulances in a specific service area based on experience and the predicted likelihood of requests for service in that area at the time deployed.

Deployment:
The procedures by which ambulances are distributed throughout the service area. Deployment includes the locations at which the ambulances are placed (or posted) and the number of ambulances placed in service for the particular time period.

Dispatch Time:
Common unit of measurement from receipt of a call until a unit has been selected and notified it has an assignment.

Emergency:
An unforeseen condition of a pathophysiological nature, which a prudent lay person, possessing an average knowledge of health and medicine, would judge to require urgent and unscheduled medical attention.

Emergency Medical Dispatch (EMD):
A process (pioneered by Dr. Jeff Clawson, MD, of Salt Lake City) in which protocols are used to prioritize calls for assistance and pre-arrival instructions are provided to the caller.

Emergency Medical Services (EMS):
This refers to the full spectrum of pre hospital care and transportation (including inter-facility transports), encompassing bystander action (e.g., CPR), priority dispatch and pre-arrival instructions, first response and rescue service, ambulance services, and on-line medical control.

EMS Administrative Agency:
The agency established by one or more local governments to monitor performance of the master ambulance service contract to perform various administrative services and functions.

EMS System:
The EMS System consists of those organizations, resources and individuals from whom some action is required to ensure timely and medically appropriate response to medical emergencies.

Emergency Medical Technician (EMT):
A licensed or certified person who performs basic life support.

EMT-D:
An EMT who has received additional training to administer cardiac defibrillation via an automatic defibrillator.

En-route Time (Out of Chute):
The elapsed time from unit alert to unit en-route.
For emergency requests, an out-of-chute standard of 30 seconds maximum is not uncommon.

First Responder:
The initial response to more serious emergencies by a non-transporting rapid response unit, usually capable of performing basic life support procedures, and in some systems, automatic defibrillation.

Some first responders operate at the paramedic level and render ALS care to the patient prior to the arrival of the ambulance, which may be staffed by paramedics. In high-performance systems, the early arrival by a paramedic first responder engine is often termed as "stopping the clock." This means that the primary response-time goal for delivery of ALS care to the patient is accomplished by the early arrival of the ALS first responder engine.

The purposes of first responders are to:
* Provide initial patient care very rapidly
* Provide extra staffing at the scene of complex situations
* Provide extra staffing on board the ambulance during transport of critical patients
* Provide redundant response to serious emergencies as an added safety measure

It is generally accepted that all good EMS systems incorporate a first responder component.

Fee-For-Service:
A method of reimbursing for services rendered. In an insurance plan, a schedule of benefits covered is prepared and a fee is established for each benefit. This becomes the fee for service.

This definition can also be applied to non-insured patients (self-pays) or benefits not covered by insurance plans. In this case, a schedule of services and fees would be available at the location rendering the service. This is the usual method of billing by the majority of the country's ambulance services.

Fractile Response-Time Measurement:
A method of measuring ambulance response times in which all-applicable response times are stacked in ascending length. Then, the total number of calls generating response within eight minutes (for example) is calculated as a percent of the total number of calls.
A 90th percentile, or 90 percent, standard is most commonly used. When a 90th percentile response time standard is employed, 90 percent of the applicable calls are answered in less than eight minutes, while only 10 percent take longer than eight minutes.

Indirect Cost:
A cost that cannot be identified directly with a particular activity, service or product of the program experiencing the cost.

Indirect costs are usually appointed among the program's services in proportion to service's share direct costs.

Inflation-Indexed Charge:
A limitation placed by Medicare on reasonable charges for ambulance services to restrict annual updates to an inflation adjustment factor.

Intervention Time:
The actual time spent by field personnel directly with the patient, including treatment at the scene and transport to the destination.

Life-Threatening Emergencies:
Those situations determined in accordance with the local medical direction that are likely to result in loss of life without immediate intervention.

Master Contract:
The contract document labeled Master Contract for Paramedic Ambulance Service, An agreement between the sponsoring unit of local government's EMS Administrative Agency and the ambulance contractor.

Medical Control-On-Line:
The availability of "live" medical consultation and direction via radio or telephones from a base hospital.

Medical Director:
The physician under whose license and authority EMTs and paramedics provide services.

Mutual Aid:
The ambulance service provided within the Contract Service Area by neighboring providers other than the ambulance contractor at the request of the ambulance contractor, pursuant to an agreement governing the exchange of service assistance when requested.

Non-Allowable Charge:
A charge for service that is not recognized as payable by a third-party payer because the service is not covered under the plan. Also, charges for covered services that are above those allowed under reasonable, customary or prevailing charges.

Non-Life Threatening Emergencies:
Those situations determined, in accordance with local medical direction, as not likely to result in the loss of life.

On-Scene Time:
The elapsed time from unit arrival on scene to initiation of transport.

Paramedic:
An individual trained and licensed to perform advanced life-support (ALS) procedures under the direction of a physician. Also know as an EMT-P.

Patient Mix:
The numbers and types of patients served by a hospital or other health program. Patients may be classified according to their geographic location, socioeconomic characteristics, diagnoses or severity of illness.

Peak Load Staffing:
The design of shift schedules and staffing plans so that coverage by crews matches the System Status Plan's requirements. (NOTE: peak load demand will trigger peak load staffing coverage)

Post-to-Post Move:
Movement of an ambulance from one designated posting (positioning) location to another designated post.

Post:
A designated location for ambulance placement within the system status plan (SSP). Depending upon its frequency and type of use, a "post" may be a facility with sleeping quarters or day rooms for crews, or simply a street-corner or parking lot location to which units are sometimes deployed.

Priority Dispatching:
A structured method of prioritizing requests for ambulance and first responder services based upon highly structured telephone protocols and dispatch algorithms. Its primary purpose is to safely allocate available resources among competing demands for service.

Productivity:
The measures of work used in the ambulance industry that compare the used resources (unit-hours) with the production of the work product (patient transports). Productivity is expressed and calculated by determining the number of transports per unit-hour.

Prospective Reimbursement:
Any method of paying ambulance services or hospitals in which amounts or rates of payment are established in advance for the coming year. The programs are paid these amounts regardless of the costs actually incurred. These systems of reimbursements are designed to introduce a degree of constraint on charge or cost increase by setting limits on the amount paid during a future period. (Synonymous with prospective payment.)

PSAP:
Public safety answering point - i.e., a communications center capable of receiving 911 calls. In some systems, the EMS control centers serves as a "secondary" PSAP, meaning that any 911 caller can be directly transferred to the EMS control center.

Reasonable Charge:
Under Medicare, it is the lowest of the actual charge, the customary charge of the provider, the prevailing charge in the locality, the inflation-indexed charge and other factors that may be found to affect the reasonableness of the charge.

Response Time: 
The elapsed time from the moment the call is received until the unit arrives on the scene, from the patient's point of view.

Revenue:
Increases to equity from any source. Ambulance sales are usually reported as gross (billed) revenue amounts or in net terms that reflect adjustment for write-offs.

Subsidy:
Revenues provided to an ambulance service from local government tax sources.

System Standard of Care:
The combined compilation of all priority-dispatching protocols, pre-arrival instruction protocols, medical protocols, protocols for selecting destination hospitals, standards for certification of pre-hospital personnel, as well as standards governing requirements for on-board medical equipment and supplies, and licensing of ambulance services and first responder agencies. The System Standard of Care simultaneously serves as both a regulatory and contractual standard.

System Status Controller (SSC):
Personnel with special SSM training (usually paramedics who have completed Level 2 SSM training) who are responsible for on-line implementation and management of the system status plan.

System Status Management:
The process of matching the production capacity of an EMS system to the changing patterns of demand placed on the system. SSM is designed to manage the system's resources before and between calls.

System Status Manager:
An experienced System Status Controller with advanced SSM training (Level 3) who manages control center operations and oversees the development and continuous refinement of the SSP.

System Status Plan:
A planned protocol or algorithm governing the deployment and event-driven re-deployment of system resources, both geographically and by time of day/day of week.
Every system has a system status plan. The plan may or may not be written, elaborate or simple, efficient or wasteful, effective or dangerous.

Transport Volume:
The actual number of requests for service that result in patient transport.

Unit Activation Time:
The time interval on an ambulance call measured from the time the ambulance crew is first notified to respond until it is actually en route to the scene.

Unit Hour (UH):
One hour of service by a fully equipped and staffed ambulance assigned to a call or available for dispatch.

Unit Hour Utilization (UHU) Ratio:
A measurement of how hard and how effectively the system is working.
It is calculated by dividing the number of transports (not calls) initiated during a given period of time, by the number of unit hours (hours of service) produced during the same period of time.

Units involved in long-distance transfer work, special event coverage and certain other classes of activity are excluded from these calculations.

Unit Response Time:
The time interval of an ambulance call measured from the time the ambulance crew is first notified to respond until it actually arrives at the scene.

Usual, Customary and Reasonable (UCR):
A method of payment that allows the ambulance service's usual charge as long as it does not exceed the customary allowance, or the amount customarily charged for the service by the other ambulance services in the area, unless it is determined to be a reasonable amount for the services rendered.

Utilization:
A measure of work that compares the available resources (unit-hours) with the actual time that those unit-hours are being consumed by productive activity. The measure is calculated to determine the percentage of unit-hours actually consumed in productivity with the total available unit-hours.

Workload:
A measure of work performed by on-duty units during any given period of time.



Source: American Ambulance Association - Guide for Contracting Emergency Ambulance Services