A letter provided to patients informing them of insurance noncoverage in case they refuse hospital discharge or insist on
continued hospitalization despite the review by the peer review organization (PRO) that indicates their readiness for discharge. (abbreviation)
The process of collecting in-depth information about a person’s situation and functioning to identify individual needs in order to
develop a comprehensive case management plan that will address those needs.
The deliberate organization of patient care activities between two or more participants (including the patient) involved in
patient's care to facilitate the appropriate delivery of health care services. (2 words)
A type of review used to determine that the hospital admission is appropriate, clinically necessary, justified, and reimbursable (2 words)
Designation given to eligible rural hospitals by CMS which is
designed to reduce the financial vulnerability of rural hospitals and
improve access to healthcare by keeping essential services in rural
communities. Ex: Urbana Hospital (2 words)
A collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services
required to meet the client’s health and human services needs. It is characterized by advocacy, communication, and resource
management and promotes quality and cost-effective interventions and outcomes (2 words)
Quality Improvement Organization (QIO) used in Ohio to process patient discharge appeals
The number of days that a health plan member/client stays in
an inpatient facility, home health, or hospice. (abbreviation)
A specific amount of money the insured person must pay
before the insurer's payments for covered healthcare services begin under a medical insurance plan.
A patient day in the hospital during which hospital services were
not rendered or could have been safely and appropriately
performed in an alternate or lower level of care. (2 words)
A term for the coverage gap in Medicare Part D, that causes
individuals to pay 100 percent of drug costs until the annual
deductible amount is reached.
The thoughts, communications, actions, customs, beliefs,
values, and institutions of racial, ethnic, religious, or social groups
A national law that ensures clients’ medical information is kept
confidential (abbreviation)