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In health care, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification.
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. [3]
The PPS was established by the Centers for Medicare and Medicaid Services (CMS), as a result of the Social Security Amendments Act of 1983, specifically to address expensive hospital care. Regardless of services provided, payment was of an established fee. The idea was to encourage hospitals to lower their prices for expensive hospital care.
Specifically, the Federal Nursing Home Reform Act is a part of the Omnibus Budget Reconciliation Act of 1987 which gives guidelines to regulate nursing home care in the United States. The act was intended to advance nursing home residents' rights. The Nursing Home Reform Act provides guidelines and minimal standards which nursing homes must meet.
Long-term care insurance can cover home care, assisted living, adult daycare, respite care, hospice care, nursing home, Alzheimer's facilities, and home modification to accommodate disabilities. [3] If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed.
These diagnosis and procedure codes are used by health care providers, government health programs, private health insurance companies, workers' compensation carriers, software developers, and others for a variety of applications in medicine, public health and medical informatics, including: statistical analysis of diseases and therapeutic actions
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 Management , and John D. Thompson ...
Home health is a nursing specialty in which nurses provide multidimensional [1] home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. [2] Home health nurses create care plans to achieve goals based on the client's diagnosis.