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Stack #65644

Ms. Moneybags Inpatient Hospital Billing

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