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APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the ...
The Current Procedural Terminology ( CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. [ 1] The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among ...
In 2000, the Hospital Association of Southern California (HASC) [15] [16] [17] determined that a uniform code system was needed after three people were killed in a shooting incident at a hospital after the wrong emergency code was called. While codes for fire (red) and medical emergency (blue) were similar in 90% of California hospitals queried ...
The Minimum Data Set ( MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes and non-critical access hospitals with Medicare swing bed agreements. (The term "swing bed" refers to the Social Security Act's authorizing small, rural hospitals to use their beds ...
United States, No. 23-726, 603 U.S. ___ (2024) The Emergency Medical Treatment and Active Labor Act ( EMTALA) [1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital emergency departments that accept payments from Medicare to provide an appropriate ...
Diagnosis-related group. Diagnosis-related group ( DRG) is a system to classify hospital cases into one of originally 467 groups, [ 1] with the last group (coded as 470 through v24, 999 thereafter) being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of ...
Chargemaster. In the United States, the chargemaster, also known as charge master, or charge description master ( CDM ), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.
Medical billing. Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures ...