Ch. 12-Coding and Clinical Documentation Integrity Management Flashcards
Benchmarking
The process of comparing performance with a preestablished standard or performance of another facility or group
CC/MCC capture rate
Using the MS-DRG system, it is the percent of admissions within an MS-DRG family assigned to an MS-DRG with CC, MCC, or both
Clean claim rate
A measure of the coding units or organizations ability or comply with billing edits
Clinical documentation integrity (CDI)
Program that strives to initiate concurrent and retrospective reviews of medical records to improve the quality of provider documentation
Coding compliance plan
A component of a health information management compliance plan or a corporate compliance plan that focuses on the unique regulations and guidelines with which coding professionals must comply
Coding management
Management unit responsible for organizing the coding process so healthcare data can be transformed into meaningful information required in claims processing
Computer-assisted coding (CAC)
Coding tool which uses a process of extracting and translating free-text data and electronic health record data into medical codes for billing and coding purposes
Denial rate
A measure of how well a facility or practice complies with billing rules and regulations for all payers. Specific to coding management, it is a metric used to determine if the coding unit complies with coding requirements
Discharge status code
Code reported on an inpatient claim to identify where the patient is being discharged or transferred to at the end of their stay
Discharged, not final billed (DNFB)
A measure of the health of the claims generation process. The measure can be displayed in the days or in dollars
Encoder
Software program used to facilitate the assignment of diagnostic and procedure codes according to the rules of the coding system
Key performance indicator (KPI)
Quantifiable measure used to evaluate the success of an organization, employee, and the like in meeting objectives for performance
Program for Evaluating Payment Patterns Electronic Report (PEPPER)
Hospital-specific report produced by CMS that provides statistics for discharges that are vulnerable to improper payments
Query
Provider communication tool used concurrently or retrospectively to obtain documentation clarification
