EMERGENCY

Sudden unexpected onset of illness/injury, which requires the immediate care and attention of a qualified physician, and which, if not treated immediately, would jeopardize or impair the health of the patient. Emergency may be the only acceptable reason for admission without per-certification.

PROMPT PAYMENT DISCOUNT

A contractual clause that states a discount for cases paid within “X” amount of time from the initial billing date. Usually it is 15 days from initial billing date. The discount can be a fixed % of all billed charges or a fixed % of a particular room & board type.

FOLLOW-UP DAYS (FUD)

These are the visits for follow-up care rendered during a normal surgical recovery, which is included in the fee for surgical service usually referred to as part of the “Global Surgical Package”. Small procedures often have FUD between 10-15 days. Major surgeries have FUD established between 60-90 days. However, each third party medical insurance plan can set their criteria for FUD. CMS publishes their follow-up days as part of the annual physician fee schedule.

DURABLE MEDICAL EQUIPMENT (DME)

Medical equipment and/or supplies that can be reused and/or single use items are considered durable medical equipment. Patients who are not currently injured or ill may be given supplies such as slings, orthotics, plaster cast that fall under durable medical equipment. Examples of DME are crutches, wheel chairs, hospital beds, special toilet seats, and oxygen cylinders. DME is an equipment that:

Can be used over and over again,
Is ordinarily used for medical purposes,
Is generally not useful to a person who is not sick, injured,or disabled.

NON-AVAILABILITY STATEMENT (NAS)

A Non-Availability Statement (NAS) is required before any non-emergent inpatient services may be provided to a TRICARE beneficiary by a non-Military Treatment Facility (MTF). The NAS is issued at the discretion of the MTF Commander. It is valid for 30 days after the date of issuance for the specific reason requested and obtained. The NAS remains valid from the date of admission until 15 days after discharge for follow-up treatment related to the admission stay.

COST CONTAINMENT

Control of inefficiencies in the consumption, allocation, or production of health care services that contribute to higher than necessary costs. Inefficiencies are thought to exist in consumption when health services are inappropriately utilized; inefficiencies in allocation exist when health services could be delivered in less costly settings without loss of quality; and, inefficiencies in production exist when the costs of producing health services could be reduces by using a different combination of resources.