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20 Cards in this Set
- Front
- Back
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what is ambulatory payment classification?
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groupings of outpatient services (based on the HCPCS code assigned) that determine the payment the hospital receives under the Hospital Outpatient Prospective Payment System (HOPPS)
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what is ambulatory surgery?
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also called same day surgery, that is planned when the patient will arrive at the facility, have surgery, recover from anesthesia, and be ready for discharge in a single day , thus avoiding an overnight stay in the facility.
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what is the chargemaster or charge description master (CDM)?
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a computer file that contains a list of the Healthcare Common Procedural Coding System codes and associated charges of services provided to hospital patients.
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what is a clinic outpatient?
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an outpatient treated in an organized clinic of the hospital in which hospital staff evaluate the patient and manage their care
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what is a common working file?
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a file maintained on each Medicare beneficiary in one of nine regional databases. This file contains claims history information from both part A and B claims and data on utilization patterns of Medicare beneficiaries.
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what is discounting?
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reducing the payment for additional procedures or ambulatory patient groups, so that these other items are not paid at the full rate, as they would be if they had been the only services performed in a given encounter
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what is EMTALA?
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Emergency Medical Treatment and Active Labor Act (EMTALA) a federal law that imposes a legal duty on hospitals to screen and stabilize, if necessary, any patient who arrives in the emergency department. The purpose of EMTALA is to prevent the dumping of patients who may not be able to pay for emergency department services
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what is an emergency outpatient?
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an outpatient evaluated and treated in the emergency department of the hospital
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what is fiscal intermediary? (FI)
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an organization with a contract with the CMS to process and pay Part A Medicare claims
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what is a hospital inpatient?
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a hospital patient who received care at the hospital, but who is not admitted to inpatient status
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what is Hospital Putpatient Prospective Payment System (HOPPS or OPPS)?
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Medicare's payment system for hospital outpatient services. Implemented in the year 2000, the basic unit of payment in the OPPS is the ambulatory payment classification (APC) of each service provided
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what is a Medicare carrier?
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an organization having a contract with the CMS to process and pay Part B Medicare claims
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what is an observation service?
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service furnished by a hospital on the hospital's premises, including use of a bed and periodic monitoring by a hospital's nursing or other staff which are reasonable and necessary to evaluate an outpatient's condition or determine the need for a possible admission to the hospital as an inpatient.
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what is a partial hospitalization program? (PHP)?
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an intensive treatment program in which patients receive services for part of each day. These patients would otherwise require inpatient psychiatric care.
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what is a potentially compensable event? (PCE)
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an occurence that may result in litigation against the health care provider or that may require the health care provider to financially compensate an injured party
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what is referred hospital inpatient
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one who is referred to the hospital for specific services, such as laboratory or radiological services. the hospital is responsible only for providing the diagnostic or therapeutic services, while the referring physician is responsible for evaluating and managing the patients care.
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what is a resident?
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a licensed physician, dentis, or podiatrist participating in a graduate medical education program (GME), may be a physician who is authorized to practice only in a hospital,temporary licensed, unlicensed foreign medical school graduates
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what is a revenue code?
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used on the UB-92 to indicate the general nature of the services provided. Revenue codes must be appropriate to any HCPCS codes listed with them.
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what is a status indicator?
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an alphabetic character that indicates the type of each APC and whether or how that APC is paid under the Hospital Outpatient Prospective Payment System (OPPS)
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what is a Uniform Ambulatory Care Data Set (UACDS)?
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one of the first attempts to standardize ambulatory data collection efforts. THe National Committee on Vital and Health Statistics (NCVHS) aproved the most recent revision of this 16 item data set in 1989, Since then, the NCVHS focuses on core data elements that could be used in either the impatient or outpatient setting.
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