Ch. 9 Classification Systems and Reimbursements Flashcards
Allowable costs
Charges for services and supplies for which benefits are covered under a health insurance plan.
Ambulatory payment classifications (APCs)
Groupings of services that set reimbursement rates for similar clinical services and applied to outpatient surgery outpatient clinic emergency department services in observational services.
Anatomic site
Relating to the structure of the body.
Behavior
A term used to indicate whether a tumor is malignant, benign, in situ, or uncertain is benign or malignant.
Case-mix
Describes a group made up of patients with common traits such as age, insurance provider, diagnoses, or other criteria.
Case-mix index (CMI)
A number calculated by averaging the relative weights of the hospital’s DRGs.
Charge capture and coding
The process of capturing (identifying) and coding all services provided to a patient for the purposes of billing and reimbursement.
Chargemaster
The comprehensive listing of all items billable to a patient for an insurance provider, including each medication, specific diagnosis test, minutes of anesthesia, etc.
Claim submission
The process of submitting a universal claim form documenting all billable fees to the third-party payer for reimbursement.
Classification system
A system that organizes groups or terms into categories.
Clinical documentation improvement (CDI)
A program to improve the quality of documentation to ensure that it is complete, legible, timely, concise, clear, patient-centered, and accurate.
Clinical (medical) terminology
A standard medical language.
Collections
Begins at the time of registration when any copayment or coinsurance payment is collected.
Comorbidities
Coexisting medical condition or disease process that is present as an additional diagnosis.
Compliance
Refers to acting in accordance with established rules and guidelines.
