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"?
Charges accumulating on a patient’s claim who is still receiving inpatient services and hasn’t been discharged
What are "In-House" charges?
A metric for measuring claims which have no defects or special circumstances and have a timely payment as a subset of all claims
What is the "Clean Claim or Validation Rate" (CCR)?
A file with claims sent to a payer, Institutional, services in a facility
What is the "837I" file?
HFMA
What is the acronym for the "Healthcare Financial Management Association"?
The 10th revision of the International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization
What is the ICD10?
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"?
When hospitals will hold a bill for a period of 3-7 days to allow departments to get their charges in
What are "Bill Hold Days"?
A calculation that compares the total dollar amount of claims that have been rejected by payers within a given time period to the total dollar amount of claims submitted within the same time period
What is the "Denial Rate"?
A file with claims sent to a payer, Professional, a professional's time
What is the "837P" file?
AAHAM
What is the acronym for the "American Association of Healthcare Administrative Management"?
A listing of every item, service or procedure that a hospital could provide
What is the "Chargemaster" (CDM)?
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"?
Hospital bills that have completed service but have not been billed to insurance yet
What is "Discharged, Not Final Billed" (DNFB)?
Outstanding charges that are the patient's responsibility that have not been successfully collected which are eventually written off and sent to a collection agency
What is "Bad Debt"?
An transaction set and electronic version of an Application Advice document, used to notify the sender of a previous transaction that the document has been accepted, or to report on errors
What is the "824" file?
MGMA
What is the acronym for the "Medical Group Management Association"?
A bill that uses several commonly used ICD-10 codes
What is a "Superbill"?
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"?
Tracking of dollars not submitted to payers; when claims are tracked to make sure they are submitted to meet filing requirements, measured by how many "days" of revenue are sitting in the total unbilled
What is "Unbilled A/R"?
A calculation that compares the Total Outstanding A/R to Average Daily Revenue
What is "Gross Days Revenue or Receivables Outstanding" (GDRO)?
A payment file sent back to the provider
What is an "835" file?
AHIMA
What is the acronym for the "American Health Information Management Association"?
A unique physician identification number, discontinued in 2007 and replaced by NPI
What is the "UPIN"?
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)?
An alphabetical list of accounts receivable with outstanding balances
What is an "Aged Trial Balance"?
A calculation that compares Total A/R Aged over 90 days to Total Accounts Receivable
What is "Aging Over 90 Days"?
A claims acknowledgement from an inquiry
What is a "277" file?
A 10-digit provider id number
What is the "NPI"?
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"?
An institutional paper claim form
What is the "UB04"?
An inquiry transaction about a claim
What is a "276" file?
A summary of daily patient treatments, charges and payments received
What is a "Day Sheet"?
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"?
Used by hospitals and healthcare centers when submitting bills to Medicare and 3rd party payors for reimbursement
What is the "UB04"?
A file that contains information regarding the Patient Information Transaction set
What is a "275" file?
Standardized code sets that are necessary for Medicare and other health insurance providers to provide healthcare claims that are managed consistently and in an orderly manner
What is the "HCPCS"?
This is a healthcare program that supports low-income families or individuals
What is "Medicade"?
A notice you receive from Medicare explaining the benefits received and not received
What is the "EOB or EOMB"?
HIPPA-compliant files requesting eligibility details for a patient
What is a "271" file?
An editor from the government that edits a variety dimensions/facets of a claim
What is the "OCE"?
A system that helps get claims out to secondary payers faster
What is "Accelerated Secondary Billing" (ASB)?
A professional paper claim form
What is the "CMS 1500"?
A file returned to Epic
What is a "CRD" file?
The local coverage determination and editing system from CMS
What is the "LCD"?
Any information in a medical record that can be used to identify an individual
What is "Protected Health Information" (PHI)?
The HIPPA electronic transaction standards, replaced 4010
What is a "5010" file?
A unique number that identifies the patients’ medical record
What is the "MRN"?