Ms. Moneybags Inpatient Hospital Billing
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| cc | CHIEF COMPLAINT
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| CC | COMPLICATIONS AND COMORBIDITIES
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| Principal Diagnosis | The condition AFTER study that is established as chiefly responsible for a patients' admission to the hospital
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| Chief complaint | What the patient states is the main reason for them seeking medical attention
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| Complication | condition an admitted patient develops AFTER surgery or treatment that affects the length of stay in the hospital or course of treatment
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| Comorbidity | Admitted patient's coexisting condition that affects the length of stay in the hospital or course of treatment
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| Adjunct codes | codes not reported alone. Only assigned in addition to the principal procedure
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| Principal Procedure | The main service performed for the condition listed as the principal diagnosis
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| Hospice | care of terminally ill patients with the life expectancy of 6 months or less
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| ASC | Ambulatory Surgery Center
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| SNF | Skilled Nursing Facility
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| Form Locators | Record unique required data in required fields of the claim form.
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| UB-92 | Claim form introduced in 1992. Known as Uniform Bill -92.
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| HHA | Home Health Agency
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| TIN or EIN | federal Tax Identification Number or Employer Identification Number.
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| Covered days | Total number of days covered by the primary payer
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| Noncovered days | Days of care not covered within the statement coverage period
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| UHDDS | uniform hospital discharge data set
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| Sign | Objective medical complaint that can be observed by another person, typically a medical professional
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| Symptom | Subjective medical complaint reported by the patient that can not be observed
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| Unconfirmed condition | "rule out" "probable" "possible" "likely" . Diseases or diagnoses identified by a physician in medical record as possible, probable or likely but not confirmed by a final diagnosis
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| DRG | Diagnosis related group
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| per diem reimbursement | based on a per day charge
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| MDC's | Major Diagnostic categories
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| Diagnosis Related Group | identified as 3 digit number, are driven by the principal diagnosis, age and disposition of the patient. used for reimbursement for hospitals.
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| CMI | case mix index
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| case mix Index | provides information on the type of patients treated by third-party payer
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| UPIN | unique physician identification number
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| Prevailing charge | the average of charges by hospitals of similar size and area demographics
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| HIM dept | Health Information management
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| Endowment funds | special interest funds held and controlled by a hospital. financial assistence to help needy patients cover services rendered
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| Spell of illness | Inpatient benefit period. Defined as a period of consecutive days.
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| Non liquid assets | personal property and real estate that are not easily converted to disposable income
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| Liquid asset examples | checking account, cash on hand, stocks, bonds and monthly income
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| AMLOS | arithmetic mean length of stay
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| Arithmetic mean length of stay | The average number of days patients within a given DRG stay in the hospital, also referred to as the average length of stay
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| GMLOS | Geometric mean length of stay
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| geometric mean length of stay | used to determine payment only for outlier cases
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| Surgical hierarchy | an ordering of surgical cases from most to least resource intensive. Is necessary when patient stays involve multiple surgical procedures, each of which, occuring by itself, could result in assignment to a different DRG.
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| DRG volume | the number of patients in each DRG
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| Cost outlier case | a case in which the costs for treating the patient are extraordinarily high in relation to the costs for other patients in the DRG
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| Grouper | The software that assigns DRG's
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| PPS | Prospective Payment system
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| RBRVS | Resource- Based Relative Value Scale
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| RUGs | Resource Utilization Groups
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| APCs | Ambulatory Payment Classificiation
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| APGs | Ambulatory Payment Groups
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| Minimum Data Set | Associated with long term care, its purpose is to increase uniformity and comparability of data collected
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| Indigent | persons who income eligibility requirements for reduced health care costs or special programs to pay for care
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| General Assistance programs | health care reimbursement programs based on higher income and asset eligibility requirements than Medicaid
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| UB-04 | Revised form which replaced the UB-92. Revised in 2004 and implemented for mandatory use in May 2007.
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Ms. Moneybags
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