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Definition
| A review for appropriations and necessity of admissions |
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| A system of outpatient hospital reimbursment based on procedures rather than diagnoses. |
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| Nineteen criteria for admission under the prospective payment system, separated into two categories, severity and intensity of illness. |
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| A system of payment used by managed care plans in which physicians and hospitals are paid a fixed per capita amount for each patient enrolled over a stated period of time, regardless of the type and number of services provided. |
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Definition
| An average after a flat rate is given to certain categories and procedures. |
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Definition
| A computer program that is linked to carious hospital departmetns and includes procedures coes, procedure descriptions, service descriptions, fees, and revenue codes. |
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| The dollar amount a hospital buills an outlier case on the itemized bill |
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Definition
| Cases that cannot adequately be assigned to an appropriate DRG owing to unique combination of diagnoses and surgeries, very rare conditions or other unique clincal reasons. |
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Definition
| The correct order of diagnostic codes when submitting an insurance claim that affects maximum reimbursement. |
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Definition
| An ongoing condition that exists along with the condition for which the patient is receiving treatment. |
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Definition
| A typical case that has an extraordinary high cost when compared with most discharges calssified to the same DRG. |
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| Preadmission Testing (PAT) |
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Definition
| Treatment and tests done 72 hours before admission. |
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Definition
| A review of potential day outliers to determine the necessity of admission and number of days before the day outlier threshold is reached as well as the number of days beyone the threshold. |
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Definition
| A patient classification system that categorized patients who are medically related with respect to diagnosis and treatment and statistically similar in length of hospital stay. |
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Definition
| To find out whether the diagnostic and procedural information affection DRG assignment is substantiated by the clincal information in the patient's chart. |
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Definition
| Coding that is inappropriately altered to obtain a higher payment rate |
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Definition
| A surgical procedure that may be scheduled in advance, is not an emergency, and is discretionary on the part of the physician and the patient. |
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Definition
| The computer software program that assigns DRGs of discharge patients using the following information, patient's age, sex, principal diagnisis, complications, co morbid conditions, principal prodecure, and discharge status. |
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Definition
| A term used when a patient is admitted to the hospital for overnight stay |
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Definition
| A condition that is chiefloy responsible for admission |
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Definition
| The automated grouper process of searching all listed diagnosis for the presence of any comorbility condition or complication or searching all procedures for operating room procedure or other specific procedures. |
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Definition
| A review of diagnosis and procedure to determine appropriateness. |
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Term
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Definition
| A patient whoi receives services in a health care center,emergency department, or ambulatory surgical center and goes home the same day. |
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Definition
| The fixed percentage of the collected premium rate that is paid to the hospital to cover services. |
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Definition
| A single charge for a day in the hospital regardless of any actual charges or costs incurred. |
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Definition
| Bone marrow collected from the patient, processed & later transplanted back into the patient. |
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Definition
| Method used to obtain exposure of a lesion; an anatomical location |
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Definition
| AKA spinal tap; obtains cerebrospinal fluid into subarachnoid space in the lumbar region. |
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Term
| Quality Improvement Organization (QIO) Program |
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Definition
| A program that replaces the peer review organization program and it designed to monitor and improve the usage and quality of care for Medicare beneficiaries. |
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Definition
| A review of patients readmitted to a hospital within 7 days with problems related to the first admission, to determine whether the first discharge was premature or the second admission is medically necessary. |
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Term
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Definition
| The process in which computer software checks for errors before a claim is submitted to an insurance carrier for payments. |
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Definition
| An agreement between a managed care company and a reinsure in which absorption of prepaid patient expenses is limited. |
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Definition
| Review of transfers to different areas of the same hospital that are exempted from prospective payments. |
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Definition
| A Uniform Bill insurance claim developed by the National Uniform Billing committee for hospital inpatient billing and payment transactions. |
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Definition
| American Hospital Association |
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Definition
| American health information management association |
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Definition
| Discribes the services of a physician, including supervision and interporetation of the report. |
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| Describes the services of the technological as well as the use of the equipment,film and other supplies. |
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Definition
| Electronic Data Interchange |
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Definition
| Fiscal intermediary, field locator |
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Definition
| General Accounting Officer |
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Definition
| Describes the combination of the professional and technical components. |
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Definition
| Bone marrow sample taken with a needle inserted into marrow cavity and pulled into a syringe. |
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Definition
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Definition
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Definition
| Outpatient Prospective Payment System |
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Definition
| Registered Health Information Administrator |
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Term
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Definition
| Registered Health Information Technician |
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Term
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Definition
| Tax Equity and Fiscal Responsibility Act |
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