Common terms & acronyms Flashcards
ACDIS
A community in which CDI professionals share strategies for successful CDI programs and achieve professional growth. It’s missions is to bring CDI specialist together. Sponsored by HCPro.
APR DRG
All Patient Refined Diagnostic Related Groupings. A severity of illness and risk of mortality profiling system which utilizes specific subclass levels.
- Subclass 1 (Minor)
- Subclass 2 (Moderate)
- Subclass 3 (Major)
- Subclass 4 (Extreme)
AHA
American Hospital Association: national association made up of member hospitals. Responsible for publishing Coding Clinic reference books. The authority on coding guidance.
ALOS or AMLOS
Average Length of Stay: a benchmark used for analysis in utilization.
Blended Rate
Each hospital is assigned a blended rate by CMS, based on cost of living, location, and services provided.
CC
Complication/comorbidity: the presence of a CC can increase reimbursement by changing the DRG assignment.
CDIS
automated concurrent review tool created by 3M to help sustain the financial benefits achieved in the clinical documentation improvement program.
CMI
Case Mix Index: the average of the weights for Medicare discharges over a specific period of time.
CMS
Centers for Medicare and Medicaid - the federal administrator of the Medicare program
Comorbidity
A pre-existing condition that causes an increase in LOS.
Complication
A condition that arises during a hospitalization that can prolong the length of stay.
Concurrent Review
Part of the utilization process that concentrates on the course of a hospitalization. A review of all clinical information during the hospital stay to determine the need for admission. Effectively reduces inappropriate admissions, identifying potential quality issues such as denials for care and premature discharges. In addition, it assists in expediting discharge planning and effectively reducing LOS.
DRG
A Diagnosis Related Group (DRG) is a grouping of Medicare inpatients used to determine the payment the hospital will receive for the admission of that type of patient. The group definition is based on diagnoses, procedures, presence of CCs, age, sex, and discharge disposition.
E/M
Evaluation and Management Services: consultations furnished by physicians using the patients presenting illness as a guiding factor and clinical judgement about the patients condition to determine the extent of key elements of services to be performed. The key elements of services are: history, examination, and medical decision making
Encoder
software system used by coding professionals to assist with coding and DRG assignment. There are many different encoder systems currently available.
Exclusions
Specified conditional or circumstances listed in a insurance policy for which the policy will not provide benefits. These are reported as PSI or MHAC’s.
HAC
Hospital Acquired Conditions: for discharges on or after October 1, 2008, IPPS hospitals will not receive additional payment for cases when one of the selected conditions is acquired during hospitalization. In such cases, payment will not be driven higher by the secondary diagnosis if it is identified as a HAC. (IPPS - inpatient prospective payment system)
