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. |