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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 Medicare prospective payment system for hospital inpatients known as Diagnosis-related group or DRGs. This OPPS, was ...
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 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 ...
Medical laboratories enroll in CLIA to qualify for Medicare/Medicaid reimbursement, nearly all providers bill patients directly for CAM laboratory tests. [10] Additionally, CAM providers are concerned by the closure of other CAM laboratories under CLIA, and have sought to avoid detection. [ 10 ]
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 ...
The ICD-10 Procedure Coding System (ICD-10-PCS) is a US system of medical classification used for procedural coding.The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U.S., contracted with 3M Health Information Systems in 1995 to design and then develop a procedure classification system to replace Volume 3 of ICD-9-CM.
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 medical screening examination (MSE) for anyone ...
Background. The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm, initially developed in 1998 by emergency physicians Richard Wurez and David Eitel. [1] It was previously maintained by the Agency for Healthcare Research and Quality (AHRQ) but is currently maintained by the Emergency Nurses Association (ENA).