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4040 wk2

abbv & term

AEP'S Appropriateness evaluation protocols
PPS Prospective payment system
SI Severity of illness
ER Emergency Room
PAT Preadmission testing
DGR Diagnosis Related Group
QIO Quality Improvement Organization
CDM Charge description master
MDC'S Major diagnostic categories
STSG Split thickness skin graft
FTSG Full thickness skin graft
ORIF Open reduction internal fixation
VBAC Vaginal birth after cesarean
PE Pressure equalization 2
IS Intensity of service
Admission Review A review of appropriateness and necessity of admissions
Capitation A system of payment used by mangaed care plans in which physicians and hospitals are paid a fixed per capita amount for each patient enrolled over a stated period of time
Charges The dollar amount a hospital bills an outlier case on the basis of the itemized bill
Code sequence the correct order of diagnostic codes when submitting an insurance claim that affects maximum reimbursement
Comorbidity An on going condition that exists along with the condition for which the patient is receiving treatment
In patient A term used when a patient is admitted to the hospital for over night stay
Looping The automated grouper process of searching all listed diagnosis for the presence of any comorbid condition of complication
Outpatient A patient who receives services in a health care facility and goes home the same day
Per Diam A single charge for a day in the hospital regardless of any actual charges or costs incurred
Procedure Review A review diagnostic and therapeutic procedures to determine appropriateness
Principal Diagnosis A condition established after study that is chiefly responsible for the admission of the patient to the hospital
Scrubbing The process in which computer software checks for errors before a claim is submitted to an insurance carrier for payment
Stop Loss A form of gerinty that may be written into a contract used to limit the exposure of cost to a reasonable level to prevent excessive loss
Transfer Review Review of transfer to different areas of the same hospital that are exempted from prospective payment
Mastectomy Surgical removal of the breast
Closed treatment Surgical procedure does not involve surgically opening the site of the fracture for the purpose of repair
Open treatment Procedure involves surgical opening of the site and visualization of the fracture for repair and treatment
Preadmission Testing Treatment, tests, and procedure done 48-72 hours before admission of a patient into the hospital
Readmission Review A review of patients readmitted to a hospital within 7 days problems related to the first admission to determine whether the first discharge was premature or the second admission is medically necessary.
Created by: markitaboyles