Glossary
Families are often expected to make decisions using language no one has explained. This glossary defines common discharge, rehab, insurance, and post-acute care terms in plain language.
Note: This is educational, not medical or legal advice. Your care team and insurer are responsible for case-specific guidance.
Appeal
A request asking the insurance company to review and reverse a denial.
Why it matters: An appeal is usually slower and more formal than a peer-to-peer review. It may require written clinical information, therapy notes, physician support, and a clear explanation of why the requested level of care is still medically necessary.
Authorization
Insurance approval for a service, stay, transfer, or piece of equipment.
Why it matters: A hospital or rehab team may agree that care is needed, but the insurer may still need to authorize payment before it can happen.
Caregiver Training
Teaching family or caregivers how to safely help with mobility, transfers, medications, equipment, wound care, or daily routines.
Why it matters: A discharge plan may depend on whether the family can safely provide the care being requested at home.
CMG
Short for Case Mix Group. In inpatient rehab, it is part of the payment system used to estimate expected resource use and length of stay.
Why it matters: Families may never hear this term directly, but expected length of stay and payment assumptions can shape discharge timing behind the scenes.
Denial
A decision by an insurance company refusing to approve or continue payment for a service, stay, transfer, or equipment.
Why it matters: A denial does not always mean care is no longer needed. It means the insurer is not agreeing to pay under its rules at that moment.
Discharge Barrier
Anything preventing a safe or realistic discharge.
Examples:
- No accepting facility
- Equipment not delivered
- Insurance denial
- No caregiver available
- Home not accessible
- Medical instability
- Medication or supply issue
Why it matters: A discharge date may be set before all barriers are resolved.
Discharge Disposition
The place or setting a person is expected to go after leaving the hospital or rehab facility.
Common examples:
- Home
- Home with home health
- Skilled nursing facility
- Long-term acute care hospital
- Outpatient therapy
- Another hospital
Why it matters: Disposition is not just a location. It determines what services, equipment, caregiver help, and insurance approvals are needed.
DME
Durable Medical Equipment. Equipment used at home or in another care setting.
Examples:
- Wheelchair
- Walker
- Hospital bed
- Bedside commode
- Shower chair
- Wound VAC
- Oxygen equipment
Why it matters: DME delays can delay discharge or make a discharge unsafe if the equipment is not delivered, approved, or appropriate.
DOC
Disorders of Consciousness. A clinical category that can include coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state.
Why it matters: Patients with DOC often need specialized care planning, careful family education, and realistic discharge planning because recovery and care needs can be complex.
Family Meeting
A meeting with the care team and family to review medical status, therapy progress, discharge options, barriers, and next steps.
Why it matters: This is often where families hear the discharge plan, but it may also be where hidden barriers become visible.
Home Health
Healthcare services provided at home after discharge.
May include:
- Nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Social work
- Home health aide services
Why it matters: Home health is intermittent. It does not mean someone will be in the home all day.
Inpatient Rehabilitation Facility / IRF
A hospital-level rehabilitation setting for patients who need intensive therapy, physician oversight, nursing care, and coordinated rehabilitation after serious illness or injury.
Why it matters: IRF is not the same as a nursing home. It is more intensive, more medically supervised, and usually shorter-term.
Length of Stay / LOS
The amount of time a patient stays in a hospital, rehab facility, or other care setting.
Why it matters: Families often experience length of stay as a clinical decision, but it can also be shaped by insurance authorization, payment rules, medical stability, therapy progress, and discharge barriers.
Level of Care
The type and intensity of care a patient needs.
Examples:
- Hospital
- Inpatient rehab
- LTACH
- Skilled nursing facility
- Home health
- Outpatient therapy
Why it matters: Insurance and care teams often argue over level of care. The question is not just “does the patient need help?” but “what setting is appropriate and covered?”
LTACH / LTAC
Long-Term Acute Care Hospital. A hospital setting for patients who still need a high level of medical care over a longer period.
Why it matters: LTACH is not the same as skilled nursing or inpatient rehab. It is usually for patients with ongoing complex medical needs, such as ventilators, complex wounds, or serious medical instability.
Medical Necessity
The standard used to decide whether a service, stay, treatment, or equipment is medically needed and appropriate.
Why it matters: Insurance denials often turn on whether the insurer agrees that something is medically necessary.
Peer-to-Peer / P2P
A conversation between a treating provider and an insurance medical reviewer after a denial or threatened denial.
Why it matters: A peer-to-peer can sometimes reverse a denial, but it is usually time-sensitive and depends on clear clinical justification.
Prior Authorization
Insurance approval required before a service, stay, transfer, or equipment is covered.
Why it matters: Even when a care team recommends something, the insurer may require prior authorization before payment is approved.
Skilled Nursing Facility / SNF
A post-acute care setting for patients who need nursing care, rehabilitation, or assistance after hospitalization but do not meet criteria for inpatient rehab or LTACH.
Why it matters: SNF care is different from hospital care and inpatient rehab. Therapy intensity, physician presence, staffing, and family expectations may be very different.
Therapy Tolerance
A patient’s ability to participate in therapy safely and consistently.
Why it matters: Therapy tolerance can affect whether a patient qualifies for inpatient rehab, skilled nursing, home health, or another discharge plan.