Reimbursement Terminology

Question 1

A measure of how sick patients are

Answer 1

Acuity

Question 2

Auxilary or supplemental services rendered in patient care such as physical therapy

Answer 2

Ancillary Services

Question 3

The best known value for a specific measure, from any source

Answer 3

Benchmark

Question 4

Desirable levels of key financial indicators established at the start of the budget process by the governing board.

Answer 4

Budget Guidelines

Question 5

Forecasts of cash income and outgo by period.

Answer 5

Cash Flow Budget

Question 6

Payment for each hospital stay regardless of actual care costs and length of stay.

Answer 6

Case Rate

Question 7

Is the government bureaucracy that oversees health care provision for Medicare and Medicaid beneficiaries.

Answer 7

CMS - Center for Medicare and Medicaid Services

Question 8

Anticipated volumes of demand or output with emphasis on direct costs controllable by the responsibility center or unit.

Answer 8

Cost Budget

Question 9

Groups of inpatient discharges with final diagnoses that are similar clinically and in resource consumption; used as a basis of payment by the Medicare program, and as a result, widely accepted by others.

Answer 9

DRG - Diagnostic Related Group

Question 10

The costs of resources used directly in an activity that can be controlled through the unit accountable for the activity.

Answer 10

Direct Cost

Question 11

Payment for each service provided

Answer 11

Fee for service

Question 12

Expectations of future financial performance composed of income and expenses.

Answer 12

Financial Budgets

Question 13

Hospital - These owned by private corporations that declare dividends or distributions to individuals.

Answer 13

For-Profit-Hospital

Question 14

A scoring system driven by the OASIS which determines reimbursement allotment for home health care.

Answer 14

HHRG - Home Health Resource Group

Question 15

health insurance plans emphasizing comprehensive care under a single insurance premium and using a variety of devices to control cost and quality.

Answer 15

HMO - Health Maintenance Organization

Question 16

The official system of assigning codes to diagnoses and procedures associated with hospital utilization in the US.

Answer 16

ICD-9 Codes

Question 17

Cost incurred for large aggregates of the organization that cannot be directly attributed to components or responsibility centers.

Answer 17

Indirect Costs

Question 18

These are licensed facilities that provide rehabilitation care services on a post acute, inpatient basis.

Answer 18

IRF - Inpatient Rehabilitation Facilities

Question 19

An intermediary bearing insurance risk

Answer 19

Insurance Carrier

Question 20

Network of healthcare providers and organizations which provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the clinical outcomes.

Answer 20

IDN - Integrated Delivery Network

Question 21

A system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A

Answer 21

IPPS - Inpatient Prospective Payment System

Question 22

The total # of days a patient is in hospital.

Answer 22

LOS - Length of stay

Question 23

Are certified facilities that furnish extended medical and rehab care to people who are clinically complex - average stay of 25 days.

Answer 23

LTHC - Long Term Care Hospitals

Question 24

an assessment form which provides patient clinical info to help determine reimbursement for a SNF.

Answer 24

MDS - Minimum Data Set

Question 25

Governmental assistance for care of the poor, and occasionally, the near-poor.

Answer 25

Medicaid

Question 26

Government insurance for the elderly

Answer 26

Medicare Part A

Question 27

Government insurance for outpatient and ancillary services.

Answer 27

Medicare Part B

Question 28

The comprehensive assessment that drives the HHRG and reimbursement for patients in home health.

Answer 28

OASIS - Outcome and Assessment Information Set

Question 29

A forecast of responsibility center costs, aggregate expenditures, and revenue.

Answer 29

Operating Budget

Question 30

Services rendered by medical care providers in setting that does not require overnight stays.

Answer 30

Outpatient

Question 31

The group of payers that reimburses within a particular institution.

Answer 31

Payer Group

Question 32

Payment for each hospital day regardless of actual patient care costs.

Answer 32

Per Diem

Question 33

A healthcare financing plan that encourages subscribers to seek care from selected hospitals, doctors, and other providers with whom the PPO has established a contract; often and intermediary arrangement w/insurance risk remaining with the employer.

Answer 33

PPO - Preferred Provider Organization

Question 34

Organizations led by doctors which do not insure or provide care but which audit the quality of care and the use of insurance benefits for Medicare and other insurers.

Answer 34

PRO - Professional Review Organizations

Question 35

Payment to medical providers for services rendered.

Answer 35

Reimbursement

Question 36

A number code derived from the info on the MDS that is sent to Medicare to determine reimbursement.

Answer 36

RUG - Resource Utilization Group

Question 37

The most commonly used post acute setting, a health care institution that meet criteria for Medicaid and Medicare reimbursement for nursing care.

Answer 37

SNF - Skilled Nursing Facility

Question 38

The Social Security Act permits certain small, rural hospitals to enter into this type of agreement under which the hospital can use its beds as needed to provide either acute of SNF care.

Answer 38

Swing Beds

Question 39

Comprehensive outpatient clinics designed to treat patients with chronic, non healing wounds. Services provided typically include debridement, advanced wound care, HBO, growth factors, bioengineered skin grafting, etc etc.

Answer 39

WCC - Wound Care Center