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INSUR {CBCS-CPC}
Hospital Billing and Reimbursement
| Term | Definition |
|---|---|
| admitting diagnosis (ADX) | |
| ambulatory care | |
| ambulatory patient classification (APC) | |
| ambulatory surgical center (ASC) | |
| ambulatory surgical unit (ASU) | |
| at-home recovery care | |
| attending physician | |
| case mix index | |
| charge master | |
| comorbidity | |
| complication | |
| diagnosis-related group (DRG) | |
| emergency | A situation in which a delay in the treatment of the patient would lead to a significant increase in the threat to life or a body part. |
| grouper | |
| health information management (HIM) | |
| HIPAA X12 837 Health Care Claim: Institutional (837I) | |
| home health agency (HHA) | |
| home healthcare | |
| hospice care | |
| hospital-acquired condition (HAC) | |
| hospital-issued notice of noncoverage (HINN) | |
| ICD-10-PCS | |
| inpatient | A person admitted to a medical facility for services that require a stay over two midnights. |
| inpatient-only list | |
| Inpatient Prospective Payment System (IPPS) | |
| major diagnostic category (MDC) | |
| master patient index (MPI) | |
| Medicare-Severity DRG (MS-DRG) | |
| never event | |
| observation service | |
| Outpatient Prospective Payment System (OPPS) | |
| present on admission (POA) | |
| principal diagnosis (PDX) | |
| principal procedure | |
| registration | |
| sequencing | |
| skilled nursing facility (SNF) | Healthcare facility in which licensed nurses provide nursing and/or rehabilitation services under a physician’s direction. |
| three-day payment window | |
| UB-04 | |
| UB-92 | |
| Uniform Hospital Discharge Data Set (UHDDS) | |
| acute care hospitals | primarily nonprofit facilities (more than 6,000) |
| kinds of healthcare facilities | psychiatric hospitals, rehab facilities, clinics, nursing homes, subacute hospitals, and home healthcare agencies |
| SNF | skilled nursing facility |
| PDX | principal diagnosis |
| UHDDS | uniform hospital discharge data set |
| POA | present on admission |
| OPPS | outpatient prospective payment system |
| MS-DRG | Medicare-Severity DRG |
| MPI | master patient index |
| MDC | major diagnostic category |
| IPPS | inpatient prospective payment system |
| HINN | hospital-issued notice of noncoverage |
| HAC | hospital-acquired condition |
| HHA | home health agency |
| HIM | health information management |
| DRG | diagnosis-related group |
| ASU | ambulatory surgical unit |
| ASC | ambulatory surgical center |
| APC | ambulatory patient classification |
| ADX | admitting diagnosis |
| hospital size | is measured by the number of beds |
| hospital classification | by the type of facility and services they provide (teaching hospital or burn center) |
| inpatient facilities | facilities that are equipped for patients to stay overnight |
| Skilled nursing care | care given by licensed nursed under the direction of a physician |
| Skilled nursing care types | IV injections, tube feeding, and changing sterile dressings on a wound |
| long-term care facilities | nursing homes that provide custodial care for patients with chronic disabilities and prolonged illnesses |
| most familiar types of outpatient service | hospital emergency room (ERs) |
Created by:
VA_MedCod3r