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Stack #65644
Ms. Moneybags Inpatient Hospital Billing
| TERM OR ACRONYM | DEFINITION |
|---|---|
| cc | CHIEF COMPLAINT |
| CC | COMPLICATIONS AND COMORBIDITIES |
| 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
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