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Related Flashcards
Related Topics
Cards In This Set
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ROM
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Risk of Mortality - relates to the patient's likelihood of dying.
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MS-DRG w/ MCC
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Major Complication of Comorbidity - the highest SOI indicator.
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MS-DRG w/CC
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Complication or Comorbidity - a lesser level of SOI
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MS-DRG wo/CC/MCC
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No complication or comorbidity - the lowest level of SOI and sesource consumption.
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CMI
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Case Mix Index - the average relative weight and is defined as the sum of all Medcare discharges/ the number of all Medicare discharges.
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Low CMI
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Denotes MS-DRG assignments that do not adequately reflect the resources used to treat Medicare patients. This could be interpreted as low quality of care.
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High CMI
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Means the hospital performed big ticket services and may receive more money per patient.
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RAC
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Recovery Audit Contractors - a permanent nation program to identify improper payments made on claims for services provided to Medicare patients.
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IPPS
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Inpatient Prospective Pyment System - the federal government created this payment method to one based on fixed rates.
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DRGs
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Diagnosis Related Groups - aimed to categorize "like" patients with "like" treatment/charges base on the principal diagnosis and up to 8 secondary diagnosis.
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CC
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Complication and Comorbidities - certain conditions increase the complexity of the stay causing an increase in LOS.
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SOI
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Severity of Illness - relates to the extent of physiologic decompensation or organ system loss of function.
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