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When a provider agrees to accept the allowable charges as the full fee and cannot
charge the patient the difference between the insurance payment and the provider's
normal fee. - 🧠 ANSWER ✔✔Accepting Assignment
The patient's ability to obtain medical care. The ease is determined by such
components as the availability of medical services and their acceptability to the
patient, the location of health-care facilities, transportation, hours of operation and
cost of care. - 🧠 ANSWER ✔✔Access
A number assigned to each account. This number is used to identify the account
and all charges and payments received. - 🧠 ANSWER ✔✔Account Number
Medical attention given to patients with conditions of sudden onset that demand
urgent attention or care of limited duration when the patient's health and wellness
,would deteriorate without treatment. This care is generally short-term rather than
long-term or chronic care. - 🧠 ANSWER ✔✔Acute Care
A level of healthcare delivered to patients experiencing acute illness or trauma.
Generally short-term (<30 days). - 🧠 ANSWER ✔✔Acute Impatient Care
Patients who are scheduled for services less than 24 hours in advance of the actual
service time. - 🧠 ANSWER ✔✔Add Ons
Insurance company representative. - 🧠 ANSWER ✔✔Adjustor
Costs associated with creating and submitting a bill for services, which could
include: registration, utilization review, coding, billing, and collection expenses. -
🧠 ANSWER ✔✔Administrative Costs
The process of third-party payer notification of urgent/emergent inpatient
admission within specified time as determined by payers (usually 24-48 hours or
next business day). - 🧠 ANSWER ✔✔Admission Authorization
The first date the patient entered the hospital for a specific visit. - 🧠 ANSWER
✔✔Admission Date
Word, phrase, or International Classification of Disease (ICD10) code used by the
admitting physician to identify a condition or disease from which a patient suffers
,and for which the patient needs or seeks medical care. - 🧠 ANSWER ✔✔Admitting
Diagnosis
The physician who writes the order for the patient to be admitted to the hospital.
The physician must have admitting privileges at the facility providing the
healthcare services. - 🧠 ANSWER ✔✔Admitting Physician
A notice that a care provider should give a Medicare beneficiary to sign if the
services being provided may not be considered medically necessary and Medicare
may not pay for them. Allows the beneficiary to make an informed decision prior
to services regarding whether or not they wish to receive services. Are not
routinely given to emergency department patients. - 🧠 ANSWER ✔✔Advance
Beneficiary Notice
A written instruction relating to the provision of healthcare when a patient is
incapacitated. It could include appointing someone to make medical decisions, a
statement expressing the patient's wishes about anatomical gifts (i.e. organ
donation) and general statements about whether or not life sustaining treatments
should be withheld or withdrawn. - 🧠 ANSWER ✔✔Advance Directive
Among applicants for a given group or individual program, the tendency for those
with an impaired health status, or who are prone to higher than average utilization
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, of benefits to be enrolled in disproportionate number and lower deductibles. - 🧠
ANSWER ✔✔Adverse Selection
A name by which the patient is also "known as", or formerly known as. - 🧠
ANSWER ✔✔Alias
A prospective hospital claims reimbursement system currently utilized by the
federal government Medicaid program and the states of New York and New
Jersey. Designed to describe the complete cross section of patients seen in acute
care hospitals. Approximately 639 are defined according to the principal diagnosis,
secondary diagnoses, procedures, age, birth weight, sex and discharge status. Each
category has an established fixed reimbursement rate based on average cost of
treatment within a geographic area. Were developed to quantify the difference in
demographic groups and clinical risk factors for patients treated in hospitals. This
proprietary grouping system's (i.e. 3M) purpose is to obtain fair and accurate
statistical comparisons between disparate populations and groups. Unlike the
Diagnosis Related Group (DRG) reimbursement system, which is intended to
capture resource utilization intensity, this system captures - 🧠 ANSWER ✔✔All
Patient Diagnosis Related Groups Assignment of Benefits (APDRG)