Chapter 12: Coding and Clinical Documentation Integrity
Management
1. Benchmarking The process of comparing performance with a preestablished standard
or perfor- mance of another facility or group.
2. CC/MCC Using the MS-DRG system, it is the percent of admission within an MS-
Capture Rate
DRG family assigned to an MS-DRG with CC, MCC, or both.
3. Clean Claim Rate A measure of the coding unit's or organization's ability to comply with
billing edits.
4. Clinical Program that strives to initiate concurrent and retrospective reviews of
Docu-
medical records to improve the quality of provider documentation.
mentation
In- tegrity
(CDI) A component of a health information management compliance plan or a
corporate compliance plan that focuses on the unique regulations and
5. Coding
guidelines with which coding professionals must comply.
Compli- ance
Plan
Management unit responsible for organizing the coding process so
healthcare data can be transformed into meaningful information
6. Coding required in claims process- ing.
Manage-
Coding tool which uses a process of extracting and translating free-text
ment
data and electronic health record data into medical codes for billing and
coding purposes.
7. Computer-
assist- ed
coding (CAC)
8. Denial Rate A measure of how well a facility or practice complies with billing rules
and regula- tions for all payers. Specific to coding management, it is a
metric used to determine if the coding unit complies with coding
requirements.
9. Discharge Status Code
1/
9
, Chapter 12: Coding and Clinical Documentation Integrity
Management
10. Discharged, Code reported on an inpatient claim to identify where the patient is
Not Final being dis- charged or transferred to at the end of their stay.
Billed (DNFB)
A measure of the health of the claims regeneration process. The
measure can be displayed in days or in dollars.
2/
9
Management
1. Benchmarking The process of comparing performance with a preestablished standard
or perfor- mance of another facility or group.
2. CC/MCC Using the MS-DRG system, it is the percent of admission within an MS-
Capture Rate
DRG family assigned to an MS-DRG with CC, MCC, or both.
3. Clean Claim Rate A measure of the coding unit's or organization's ability to comply with
billing edits.
4. Clinical Program that strives to initiate concurrent and retrospective reviews of
Docu-
medical records to improve the quality of provider documentation.
mentation
In- tegrity
(CDI) A component of a health information management compliance plan or a
corporate compliance plan that focuses on the unique regulations and
5. Coding
guidelines with which coding professionals must comply.
Compli- ance
Plan
Management unit responsible for organizing the coding process so
healthcare data can be transformed into meaningful information
6. Coding required in claims process- ing.
Manage-
Coding tool which uses a process of extracting and translating free-text
ment
data and electronic health record data into medical codes for billing and
coding purposes.
7. Computer-
assist- ed
coding (CAC)
8. Denial Rate A measure of how well a facility or practice complies with billing rules
and regula- tions for all payers. Specific to coding management, it is a
metric used to determine if the coding unit complies with coding
requirements.
9. Discharge Status Code
1/
9
, Chapter 12: Coding and Clinical Documentation Integrity
Management
10. Discharged, Code reported on an inpatient claim to identify where the patient is
Not Final being dis- charged or transferred to at the end of their stay.
Billed (DNFB)
A measure of the health of the claims regeneration process. The
measure can be displayed in days or in dollars.
2/
9
