Revenue Cycle
__ is the process of preparing for the patient's care by collecting demographic information and insurance information.
preadmission
__ is when a patient is formally accepted into the hospital for care.
admission
The reason, after study, for admission to the hospital.
principal diagnosis
What does MAC stand for?
Medicare Administrative Contractor
__ is when the patient pays out of pocket for services.
self pay
_ is testing done before a procedure
preadmission testing
_ is a collection of systems and processes to ensure that facilities and resources are used maximally and are consistent with patient care needs.
utilization management
A _ is a health care provider, a health plan, or a health care clearinghouse that performs one or more of the identified transactions electronically.
covered entity.
___ are hired by the CMS to improve patient care, ensure the medical necessity of care provided, review the appropriateness of the setting, and address beneficiary complaints.
QIO (Quality Improvement Organizations)
In a _____ the health care provider knows the amount of reimbursement that will be received before the service being provided.
prospective payment system
Approval from the insurer before a test can be performed.
preauthorization
_ is an evaluation for appropriateness and necessity of admission.
admission review
a _ is the collection of data that is exchanged to convey meaning between the parties engaged in electronic data interchange.
transaction set
__ prohibits patients from being transferred to another hospital if they are medically unstable or are in active labor.
EMTALA
In _ a health care provider is given a set amount of money each moth to provide all the care for a patient for a period.
capitation
List of procedures that will only be reimbursed if performed on an inpatient basis.
inpatient only
A _ examines patients' health records to determine whether or not patients should stay in the hospital.
continued stay review
What is used to submit claims for hospital services?
UB-04
TEFRA stands for
Tax Equity and Fiscal Responsibilities Act of 1982
A _ is the primary care physician who provides the care for the patient.
gatekeeper
Outpatients stay in the hospital overnight to determine if they need admitted.
Observation
The _ is a list or database of all services, supplies, equipment, and so forth provided by the hospital and charges that are associated with them.
chargemaster
A condition that is acquired during a hospital stay is called?
hospital-acquired conditions
The _ is the prospective reimbursement system used for Medicare inpatient claims.
Inpatient Prospective Payment System
One method of a PPS is _____.
Diagnosis-related groups (DRGs)