Section 1
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CERT
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Last updated
6 years ago
Date created
Mar 1, 2020
Cards (84)
Section 1
(50 cards)
CERT
Comprehensive Error Rate Testing *pepper report data looks at percentages that compare with other sites near you
RUC
Regulatory utilization committee *part of CPT or AMA
OCE
Outpatient Code Editor
OASIS
Home health gets paid by OASIS HHRG (home health resource group)
MCC
major complication/comorbidity
SNF MDS
SNF fills out form MDS (minimum data sheet) form information on the patients functional abilities
NCHS
National Center for Health Statistics
AHA
American Hospital Association
25 MDC's
Grouped by body systems
OIG
Office of Inspector General
base rate
Payment rate assigned to hospitals to calculate diagnosis related group (DRG) reimbursement
CC
complication/comorbidity
GMLOS
geometric mean length of stay
MAC
Medicare Administrative Contractor
Abuse
Unknowingly doing it
IRF PAI
Inpatient Rehabilitation Facility Patient Assessment Instrument
UHDDS
Uniform Hospital Discharge Data Set
APR DRG
All patient refined diagnosis related group
DRG
diagnosis-related grouping
RBRVS
Resource Based Relative Value Scale
AMA
against medical advice
AMLOS
arithmetic mean length of stay
data mining
the practice of searching through data records looking for useful information Chest pain headache are targeted diagnosis who should not be admitted but rather in observation
MS DRG
Medicare severity diagnosis related group
AHIMA
American Health Information Management Association
RAC
Recovery Audit Contractor
POA indicators
Know as Y N U & W (yes, no, unknown, aw-clinically unable to determine)
APC's
Ambulatory payment classification
Transfer DRG is PACT post acute care transfer
Fraud
Knowingly perform an act for higher reimbursement
CMS
Centers for Medicare and Medicaid Services
WHO
World Health Organization
N or U
Can affect reimbursement
HAC
hospital acquired condition
CMI
Case Mix Index
ABN
Advance Beneficiary Notice
fiscal year
Starts October 1st each year for ICD-10
SBAR
situation, background, assessment, recommendation
ALOS
Arithmetic length of stay. AKA Average length of stay
POA indicator provides meaningful information for an organization's
internal performance improvement activities(HAC, SRE)
Tracheotomy or debridement can affect DRG
Can happen in either the OR or the patients room
OCE
Outpatient Code Editor
NCCI
National Correct Coding Initiative
IPPS
inpatient prospective payment system
Highest weighted DRG for Adventist Health
Tracheotomy / Transplants
NUBC
National Uniform Billing Committee Is an Organization that helps develop a billing form for hospitals of which are required to be use
What affects reimbursement
Primary diagnosis/secondary diagnosis - discharge disposition - surgeries (mcc/cc)
OPPS is the abbreviation for:
outpatient prospective payment system
Pre-MDC
Major diagnostic category
ACS
American College of Surgeons
Section 2
(34 cards)