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The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating authority for health within the United Nations System. The ICD is originally designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases.
Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group 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, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.
The National Technical Information Service (NTIS) is an agency within the U.S. Department of Commerce. The primary mission of NTIS is to collect and organize scientific, technical, engineering, and business information generated by U.S. Government-sponsored research and development, for private industry, government, academia, and the public. The systems, equipment, financial structure, and specialized staff skills that NTIS maintains to undertake its primary mission allow it to provide assistance to other agencies requiring such specialized resources.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It modernized the flow of healthcare information, stipulates how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and healthcare businesses, called covered entities, from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. With limited exceptions, it does not restrict patients from receiving information about themselves. It does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends, or other individuals not a part of a covered entity.
The Standard Occupational Classification (SOC) System is a United States government system of classifying occupations. It is used by U.S. federal government agencies collecting occupational data, enabling comparison of occupations across data sets. It is designed to cover all occupations in which work is performed for pay or profit, reflecting the current occupational structure in the United States. The 2010 SOC includes 840 occupational types.
A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. Diagnosis classifications list diagnosis codes, which are used to track diseases and other health conditions, inclusive of chronic diseases such as diabetes mellitus and heart disease, and infectious diseases such as norovirus, the flu, and athlete's foot. Procedure classifications list procedure code, which are used to capture interventional data. 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:
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. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. New editions are released each October, with CPT 2021 being in use since October 2021. It is available in both a standard edition and a professional edition.
The ICD-10 Procedure Coding System (ICD-10-PCS) is an international 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. ICD-9-CM contains a procedure classification; ICD-10-CM does not. ICD-10-PCS is the result. ICD-10-PCS was initially released in 1998. It has been updated annually since that time.
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ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Work on ICD-10 began in 1983, became endorsed by the Forty-third World Health Assembly in 1990, and was first used by member states in 1994. It was replaced by ICD-11 on January 1, 2022.
Council for Affordable Quality Healthcare, Inc. (CAQH) is a non-profit organization incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then renamed the Council for Affordable Quality Healthcare, Inc. on August 8, 2002. It is based in Washington, D.C. Previously a 501(c)6 tax-exempt organization, CAQH changed its tax status in 2016, although it remains a non-profit.
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In computing, Open Data Protocol (OData) is an open protocol that allows the creation and consumption of queryable and interoperable REST APIs in a simple and standard way. Microsoft initiated OData in 2007. Versions 1.0, 2.0, and 3.0 are released under the Microsoft Open Specification Promise. Version 4.0 was standardized at OASIS, with a release in March 2014. In April 2015 OASIS submitted OData v4 and OData JSON Format v4 to ISO/IEC JTC 1 for approval as an international standard. In December 2016, ISO/IEC published OData 4.0 Core as ISO/IEC 20802-1:2016 and the OData JSON Format as ISO/IEC 20802-2:2016.
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The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings.
The Fast Healthcare Interoperability Resources' standard is a set of rules and specifications for exchanging electronic health care data. It is designed to be flexible and adaptable, so that it can be used in a wide range of settings and with different health care information systems. The goal of FHIR is to enable the seamless and secure exchange of health care information, so that patients can receive the best possible care. The standard describes data formats and elements and an application programming interface (API) for exchanging electronic health records (EHR). The standard was created by the Health Level Seven International (HL7) health-care standards organization.
The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI), is a health care quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States in 2006. It is an example of a "pay for performance" program which rewards providers financially for reporting healthcare quality data to CMS. PQRS ended in 2016, beginning with the 2018 payment adjustment. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced this and other CMS quality programs with a new umbrella program called the Quality Payment Program (QPP), under which clinicians formerly reporting under PQRS would instead report quality data under one of two QPP program tracks: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APMs) track.
Dr. Robert A. Berenson is an American former physician and academic based in Washington, D.C. Born in Elizabeth, New Jersey.
References
- ↑ Urban Institute, "Development and Structure of BETOS 2.0 with Illustrative Data", https://www.urban.org/research/publication/development-and-structure-betos-20-illustrative-data
- ↑ Levy, Barbara. "ACS Letter to RUC Requesting Updates to BETOS" (PDF). www.facs.org. Retrieved 9 October 2012.
- ↑ "Berenson-Eggers Type of Service (BETOS)". www.cms.gov. Retrieved 15 March 2016.