Chapter 9 Key Terms Flashcards
Allowable Costs
charges for services and supplies for which benefits are covered under a health insurance plan
Ambulatory Payment Classifications (APCs)
apply to outpatient surgery, outpatient clinics, emergency department services, and observational services
Anatomic Site
relating to the structure of the body
Behavior
benign, malignant, or undetermined
Case Mix
describes a group made up of patients with common traits such as age, insurance provider, diagnosis, 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
Charge master
the comprehensive listing of all items billable to a patient or an insurance provider, including each medication, specific diagnostic 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
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
translating data into useful information requiring a standard medical language
Collections
begins at the time of registration when any co-payment or coinsurance payment is collected
Comorbidity
a coexisting medical condition or disease process that is present as an additional diagnosis (e.g. the patient with the hip fracture also has hypertension and diabetes)
Compliance
acting in accordance with established rules and guidelines
