Terms Flashcards
Abbreviated Injury Scale
An anatomically-based, consensus-derived global severity scoring system that classifies each injury by region according to its relative importance on a 6-point ordinal scale (1 = minor and 6 = maximal). AIS is the basis for the Injury Severity Score (ISS) calculation of the multiply injured patient (AAAM 2008)
ABC Codes
Codes that consist of five-character, alphabetic strings that identify services, remedies, or supplies. Codes are followed by a two-character code modifier, which identifies the practitioner type who delivered the care (Alternative Link 2009)
Aberrancy
Services in medicine that deviate from what is typical in comparison to the national norm
Abortion
The expulsion or extraction of all (complete) or any part (incomplete) of the placenta or membranes, without an identifiable fetus or with a live-born infant or a stillborn infant weighing less than 500 grams
Absolute frequency
The number of times that a score of value occurs in a data set
Abstracting
- The process of extracting information from a document to create a brief summary of a patient’s illness, treatment, and outcome 2. The process of extracting elements of data from a source document or database and entering them into an automated system
Accept assignment
A term used to refer to a provider’s or a supplier’s acceptance of the allowed charges (from a fee schedule) as payment in full for services or materials provided
Accession number
A number assigned to each case as it is entered in a cancer registry
Accession registry
A list of cases in a cancer registry in the order in which they were entered
Accountable Care Organization (ACO) Participant
An individual or group of ACO provider(s)/supplier(s) that is identified by a Medicare-enrolled TIN, that alone or together with one or more other ACO participants comprise(s) an ACO, and that is included on the list of ACO participants that is required under 425.204(c)(5) (42 CFR 425.20 2011)
Accounting of disclosures
- Under HIPAA, a standard that states (1) An individual has a right to receive an accounting of disclosures of protected health information made by a covered entity in the six years prior to the date on which the accounting is requested, except for disclosures. To carry out treatment, payment, and health care operations as provided in 164.506
Accounting rate of return
The projected annual cash inflows, minus any applicable depreciation, divided by the initial investment
Accounts payable (A/P)
Records of the payments owed by an organization to other entities
Accounts receivable (A/R)
- Records of the payments owed to the organization by outside entities such as third-party payers and patients 2. Department in a healthcare facility that manages the accounts owed to the facility by customers who have received services but whose payment is made at a later date
AAAH
Accreditation Association for Ambulatory Health Care
ACHC
An organization that provides quality standards and accreditation programs for home health and other healthcare organizations (ACHC 2013)
Accredited Standards Committee X12 (ASC X12)
A committee accredited by ANSI responsible for the development and maintenance of EDI standards for many industries. The ASC “X12N” is the subcommittee of ASC X12 responsible for the EDI health insurance administrative transactions such as 837 Institutional Health Care Claim and 835 Professional Health Care Claim forms (Accredited Standards Committee 2013)
Accrue
The process of recording known transactions in the appropriate time period before cash payments/receipts are expected or due
Acid-test ratio
A ratio in which the sum of cash plus short-term investments plus net current receivables is divided by total current liabilities
ACOG
American Congress of Obstetrics and Gynecology
Action plan
A set of initiatives that are to be undertaken to achieve a performance improvement goal
Active record
A health record of an individual who is a currently hospitalized inpatient or an outpatient
Activity-based costing (ABC)
An economic model that traces the costs or resources necessary for a product or customer
Activity date or status
The element in the chargemaster that indicates the most recent activity of anitem
Actual charge
- A physician’s actual fee for service at the time an insurance claim is submitted to an insurance company, a government payer, or a health maintenance organization; may differ from the allowable charge 2. Amount provider actually bills a patient, which may differ from the allowable charge
Acute-care hospital
Under HITECH specific to the Medicaid program, a health care facility (1)where the average length of patient stay is 25 days or fewer; and (2) with a CMS certification number (previously known as the Medicare provider number) that has the last four digits in the series 0001–0879 or 1300–1399 (42 CFR 495.302 2012)
Acute-care prospective payment system
The Medicare reimbursement methodology system referred to as the inpatient prospective payment system (IPPS). Hospital providers subject to the IPPS utilize the Medicare severity diagnosis-related groups (MS-DRGs) classification system, which determines payment rates (CMS 2012)
ADA
Americans with Disabilities Act
Addendum
A late entry added to a health record to provide additional information in conjunction with a previous entry. The late entry should be timely and bear the current date and reason for the additional information being added to the health record
Add-on codes
In CPT coding, add-on codes are referred to as additional or supplemental procedures. Add-on codes are indicated with a “+” symbol and are to be reported in addition to the primary procedure code. Add-on codes are not to be reported as standalone codes and are exempt from use of the –51 modifier (AMA 2013)
Addressable standards
As amended by HITECH, the implementation specifications of the HIPAA Security Rule that are designated “addressable” rather than “required”; to be in compliance with the rule, the covered entity must implement the specification as written, implement an alternative, or document that the risk for which the addressable implementation specification was provided either does not exist in the organization, or exists with a negligible probability of occurrence (45 CFR 164.306 2013)
Adjusted clinical groups (ACGs)
A classification system developed by John Hopkins University that groups individuals according to resource requirements and reflects the clinical severity differences among the specific groups; formerly called ambulatory care groups (IASIST 2013)
Adjusted historic payment base (AHPB)
The weighted average prevailing charge for a physician service applied in a locality for 1991 and adjusted to reflect payments for services with charges below the prevailing charge levels and other payment limits; determined without regard to physician specialty and reviewed and updated yearly since 1992
Adjusted hospital autopsy rate
The proportion of hospital autopsies performed following the deaths of patients whose bodies are available for autopsy
Administrative data
Coded information contained in secondary records, such as billing records, describing patient identification, diagnoses, procedures, and insurance
Administrative information
Information used for administrative and healthcare operations purposes, such as billing and quality oversight
Administrative safeguards
Under HIPAA, are administrative actions and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic protected health information and to manage the conduct of the covered entity’s or business associate’s workforce in relation to the protection of that information (45CFR 164.304 2013)
Administrative services only (ASO) contract
An agreement between an employer and an insurance organization to administer the employer’s self-insured health plan
Administrative simplification
As amended by HITECH, authorizes HHS to: (1) adopt standards for transactions and code sets that are used to exchange health data; (2) adopt standard identifiers for health plans, health care providers, employers, and individuals for use on standard transactions; and (3) adopt standards to protect the security and privacy of personally identifiable health information (45 CFR Parts 160, 162, and 164 2013)
Admission-discharge-transfer (ADT)
The name given to software systems used in healthcare facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system
Admission utilization review
A review of planned services (intensity of service) or a patient’s condition (severity of illness) to determine whether care must be delivered in an acute care setting
Advance beneficiary notice (ABN)
A notice that a doctor or supplier should give a Medicare beneficiary when furnishing an item or service for which Medicare is expected to deny payment. If you do not get an ABN before you get the service from your doctor or supplier, and Medicare does not pay for it, then you probably do not have to pay for it (CMS 2013)
Adverse action
A term used when an organization chooses to take action against an individual practitioner’s clinical privileges or membership; Also called licensure disciplinary action
Adverse selection
A situation in which individuals who are sicker than the general population are attracted to a health insurance plan, with adverse effects on the plan’s costs
Affinity diagram
A graphic tool used to organize and prioritize ideas after a brainstorming session
Affinity grouping
A technique for organizing similar ideas together in natural groupings
