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Hospital Billing Ch 1-5
Terms in this set (52)
An institution where the sick or injured receive medical or surgical care. A facility where patients with health care problems can go to seek diagnosis and treatment of their condition.
Organization formed in 1906 to promote public welfare by improving care provided in hospitals.
Primary mission of a hospital
To provide effective and efficient patient care
Integrated Delivery System
An organization consisting of a network of providers that are affiliated with the health system to offer patients a full range of managed health care services.
Administrative, Financial, Operational, Clinical
Four functional divisions of a hospital
Term that describes money owed to the hospital from patients, insurance companies, and government programs.
Hospital department responsible for organization, maintenance, production, storage, retention, dissemination, and security of patient health information.
Acute Care Facility
A facility designed to treat patients who experience a sudden onset of a condition, illness, or disease.
Provides medical care for specific illnesses such as cancer.
Facility that is designed to receive and treat patients who have been severely injured or are critically ill.
A service performed to identify a patient's condition
A service performed to treat the patient's condition
Service provided to chronically ill patients to help minimize the acute symptoms of a chronic or terminal illness.
A service provided to promote wellness and prevent disease.
Patient care provided to a patient who is released in under 24 hours.
Supportive services required to diagnose and treat patients, provided by various departments such as radiology, laboratory, and physical therapy.
Outpatient service provided when a physician believes the patient needs to be monitored closely for 24 hours or more.
Care is provided to a patient who is admitted to the hospital for more than 24 hours.
Involve tests or procedures performed on a specimen when the patient is not present.
Legislation implemented in 1946 that made funding available to modernize existing hospitals and build new ones.
Agency under the Department of Health and Human Services that oversees the federal responsibilities of the Medicare and Medicaid programs.
Non-governmental organizations that contract with Medicare to conduct reviews to determine the appropriateness and medical necessity of services provided to hospital patients.
Inpatient Prospective Payment System
A reimbursement system for inpatient services implemented in 1983 as mandated by the TEFRA act, that provides a predetermined payment based on the patient's diagnosis.
A law passed in 1983 authorizing DHHS to impose civil monetary penalties for Medicare and Medicaid fraud.
1985 legislation ensuring continuing coverage for employees who lost health care coverage due to a change in employment. Also addressed inappropriate discharge or transfers known as "dumping."
Legislation passed by congress to ensure public access to emergency services regardless of ability to pay.
1996 law addressing several issues such as continuity of health insurance, prevention of fraud, administrative simplification, and privacy of health information.
The official publication in which federal regulations and legal notices are published.
State Departments of Health
Agency involved in state healthcare initiatives including promoting public health and ensuring that quality medical care is provided.
Process by which an agency performs an external review and grants recognition to an organization that meets certain predetermined standards.
A national commission formed in 1951 to develop guidelines for hospitals and other health care organizations. Evaluates and accredits health care organizations nationally, based on established standards of quality for operations and medical services.
An individual or organization that works with or for a HIPAA covered entity but is not an employee of the covered entity.
An organization involved with healthcare delivery that provides health care services (providers), submits claims for services, or provides health are coverage. Providers, Payers, Clearinghouses.
HIPAA Title II
Part of the HIPAA law labeled as Preventing Health Care Fraud and Abuse, Administrative Simplification, and Medical Liability Reform. Also includes the privacy and security rules.
Individually identifiable health information that is transmitted or maintained in electronic or any other form or medium.
Agency under the DHHS that is responsible for monitoring compliance and enforcement of HIPAA privacy standards.
Agency under the DHHS that is responsible for detection and prevention of fraud and abuse. Publishes model compliance plans.
Contractors hired by CMS to carry out audits to identify and correct overpayments and underpayments.
Admission Evaluation Protocols (AEP)
Outlines appropriate conditions for a hospital admission based on IS/SI criteria. IS refers to the intensity of service. SI refers to the severity of illness.
The process of gathering charge information and recording it on the patient's account.
Computerized system used by the hospital to inventory and record services and items provided by the hospital. Commonly referred to as chargemaster.
Charges that represent the cost and overhead for the technical component of patient care services, which include space, equipment, supplies, drugs, and technical staff.
A form used by the hospital to obtain the patient's authorization for treatment, which must be signed before the patient can be treated.
A unique identification number assigned by the hospital to each patient's medical record.
Charges that represent physician and non-physician clinical services (usually not billed by the hospital.)
Surgery that is performed on the same day the patient is discharged. May be performed in a freestanding surgery center or in a hospital.
The uniform hard copy of the claim form used by institutional providers to submit hospital facility charges for services, procedures, and items to payers for reimbursement.
A computer program used to assist with code assignment.
A four-digit number assigned to each service or item provided by the hospital that designates that type of service or where the service was performed.
Room and Board provided to inpatients at the hospital
the 72-hour rule
Outpatient services performed within 3 days of an inpatient admission are to be reported on the claim as part of the inpatient stay so long as the services are related to the inpatient stay
THIS SET IS OFTEN IN FOLDERS WITH...
Hospital Billing Final Exam Study Guide
Medicare Hospital Prospective Payment Systems
Hospital Billing Claim Forms
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