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Admission Review

A review for appropriateness and necessity of admissions

Ambulatory Payment Classification

A system of outpatient hospital reimbursement based on procedures rather than diagnosis


A transfer, after an event insured against, or an individual's legal right to collect an amount payable under an insurance contract

Certified Professional Coder

A title received by a person after appropriate training and the passing of a certification examination administered by the American Academy of Professional Coders

Charge Description Master

A computer program that is linked to various hospital departments and includes procedure codes, procedure descriptions, service descriptions, fee, and revenue codes; AKA: charge master

Claims Inquiry Form

Medicaid appeal form. (remittance adivce detail)

Compliance Program

A management plan composed of policies and procedures to accomplish uniformity, consistency, and conformity in medical record keeping that fulfills official requirements

Diagnosis-Related Groups

A patient classification system that categorizes patients who are medically related with respect to diagnosis and treatment and statistically similar in length of hospital stay


The name of a disease, anatomic structure, operation, or procedure, usually derived from the name of a place where it first occurred or a person who discovered or first described it

Fiscal Intermediary

For TRICARE and CHAMPVA, the insurance company that handles the claims for care received within a particular state or country. AKA: fiscal agent, fiscal carrier, and claims processor

Optical Character Recognition

A device that can read typed characters at very high speed and conver them to digitized files that can be saved on disk. AKA: intelligent character recognition (ICR)

Prospective Payment System

A method of payment for Medicare hospital insurance based on diagnosis-related groups (DRGs) (a fixed dollar amount for a principal diagnosis)

Professional Review Organization

groups established to review hospital admission and care. now termed QIO (Quality Improvement Organization)


Assets or debts that have been determined to be uncollectable and are therefore adjusted off the accounting books as a loos

Uniform Bill Claim Form

A Uniform Bill insurance claim form developed by the National Unform Billing Committee for hospital inpatient billing and payment transactions

Transfer review

Review of transfers to different areas of the same hospital that are exempted from prospective payment

Preadmission Testing

Treatment, tests, and procedures done 48-72 hours before admission of a patient into the hospital. This is done to eliminate extra hospital days


A requirement of some health insurance plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary

Phantom Billing

Billing for services not performed

Medical Record

Written graphic information documenting facts and events during the rendering of patient care

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