Definition of Terms
May 22, 2013
Definition of Terms People working with health information technology (HIT) systems must familiarize themselves with key terms to help them perform their assigned work tasks. The terms below help health care organizations to operate more accurately and efficiently. By applying these tools and resources, health care organizations and professionals provide better services and a continuum of care to their patients. Key terms include acronyms, such as AMR, CMR, CMS, CMS-1500, CPT, DRG, EPR, HL7, ICD-9, and UB-92. The following excerpt will translate and define these acronyms and describe the most important aspect of these key terms.
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Health care professionals and suppliers use standard paper claim form CMS-1500 “to bill Medicare carriers or Part A/B and Durable Medical Equipment Medicare Administrative Contractors (A/B MACs and DME MACs)” (Centers for Medicare, n.d., p. 1). Medicare only accepts this form for reimbursement. Current procedural terminology (CPT) represents code numbers physicians use to document the level of services provided to patients. In addition, insurers use these code numbers to determine the amount of money they will reimburse to physicians. They serve as a uniform approach to coding for health care organizations. The American Medical Association (AMA) created CPT codes, and they hold the responsibility for maintaining them. The AMA holds the copyrights to CPT codes. More important, even though uniformity exist in understanding the service provided, insurers reimburse physicians at different rates. The American Health Lawyers Association (AHLA) explains the term “diagnostic-related group” as: a statistical system of classifying any inpatient stay into groups for the purposes of payment. The DRG classification system divides possible diagnoses into more than 20 major body systems and subdivides them into almost 500 groups for the purpose of Medicare reimbursement. (Stanberry, 2012, para. 1)
Insurers reimburse hospitals a fixed rate for inpatient services assigned by a DRG. Other factors considered in the reimbursement rate include