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4040 wk2
abbv & term
| Question | Answer |
|---|---|
| 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
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