Hospital Terms
This acronym describes "Short-term acute care"
What is "STAC"?
This is a system that contains a digital version of a patient’s paper chart.
Examples: Meditech, Epic, Cerner, CPSI, etc.
What is an "EHR or EMR"?
The United States federal government health insurance program for Americans who are 65 years of age or older
What is "Medicare"?
This acronym refers to point-of-service
What is "POS"?
What is the acronym for Blue Cross Blue Sheild
This acronym describes "Long-term acute care"
What is "LTAC"?
This is a shared instance of a larger EMR (Epic, Cerner, etc.) that certain hospital systems can provide to smaller regional facilities. Often available at a lower cost but limited in customization options.
What is a "Community Connect"?
Supplemental health insurance for Medicare
What is "Medigap"?
This acronym refers to a treatment authorization request
What is a "TAR"?
What is the acronym for United Health Care
What is UHC
This is a designation given to eligible rural hospitals by CMS and was put in place to reduce the financial vulnerability of rural hospitals
• 25 or fewer acute care inpatient beds
• Located more than 35 miles from another hospital
What is a "Critical Access Hospital" (CAH)?
This is a subsystem of a hospital information system used for storing financial data, calculating healthcare costs, and providing billing information.
What is a "Patient Accounting System" (PAS)?
These are costs that are a patient's responsibility for hospitalization between day 61-90 days
What are "Medicare Coinsurance Days"?
A responsible party and/or insured party who is not necessarily the patient.
Who is a "Guarantor"?
What is the term when Medicare patients have additional insurance that doesn't replace their Medicare benefits
What is a Medicare supplement
This program is intended to increase access to primary care in rural communities, to receive certification, they must be located in rural, undeserved areas.
What is a "Rural Health Clinic" (RHC)?
Prior to submitting claims, the organization/technology scrubs a claim and checks for errors then electronically transmits claim information that is compliant with HIPAA standards.
What is a "Clearinghouse"?
This term refers to an entity or a private company that has a contract with CMS to determine and to pay part A and some part B bills, such as bills from hospitals, on a cost basis and to perform other related functions
What is a "Fiscal Intermediary" (FI)?
This is sometimes required by a patient’s insurance company to determine medical necessity, but does not guarantee benefits will be paid
What is "Pre-Certification"?
What is the version of Tricare for Medicare recipients
What is "Tricare for life"?
This acronym describes a "Skilled Nursing Facility"
What is a "SNF"?
The use of electronic information and telecommunications technologies to support long-distance clinical health care
What is "Telehealth"?
This term refers to a request for additional documentation on the claim
What is an "Additional Development Request" (ADR)?
This is also known as a waiver of liability, and is a notice a provider should give you before your receive a service.
What is an "Advanced Beneficiary Notification" (ABN)?
What is the term used to describe the amount an individual must pay out of pocket before their health insurance coverage begins?
Deductible
They make up more than half of all hospitals in the United States, they provide essential access to inpatient, outpatient and emergency services in rural communities
What is a "Rural Hospital"?
This software aims to rid medical claims of errors and omissions
What is a "Claims Scrubber"?
This systems allows you to check Medicare beneficiary eligibility data in real-time and is used to prepare accurate Medicare claims, determine beneficiary liability, or check eligibility for specific services
What is "HIPAA Eligibility Transaction System" (HETS)?
This is a medical billing term to describe the employee who is a part of a group policy
What is a "Subscriber"?
What is the term used to describe the fixed amount an individual pays for covered medical services after meeting their deductible?
Copayment
The prices that hospitals get paid from Medicare for certain services. CAHs receive different reimbursement given their designation otherwise.
What is the "Prospective Payment System" (PPS)?
This is a method where Medicare signals back to provider that they are going to reject a claim, and therefore, allows the opportunity to fix before final adjudication
What is "Return to Provider" (RTP)?
A confirmation of coverage
What is "Eligibility"?
This is a healthcare program that supports low-income families or individuals
What is "Medicaid"?
What is the term when determining what Insurance pays first
COB
A system that helps get claims out to secondary payers faster
What is "Accelerated Secondary Billing" (ASB)?
What is the purpose of pre-authorization in health insurance?
To obtain approval for certain medical services or procedures
Any information in a medical record that can be used to identify an individual
What is "Protected Health Information" (PHI)?