44:66:01:01. Definitions. Terms used in this article
mean:
(1) "Case severity
rating," the relative value reflecting average resource consumption by
patients in a hospital for its APR DRGs over a particular period of time;
(2) "Charge,"
that amount a hospital would expect to charge for an inpatient
diagnostic-related group;
(3) "Department,"
the South Dakota Department of Health;
(4) "All patient
refined diagnosis-related group," "APR DRG," a classification
assigned to an inpatient hospital service claim based on the patient's age and
sex, the principal and secondary diagnoses, the procedures performed, and the
discharge status;
(5) "CMS Uniform
Bill-04," "UB-04," a standardized form from the Centers for
Medicare and Medicaid Services used to electronically submit claims for health
care received in an institutional setting to payers;
(6) "Hospital
variation," any of several factors, including cross subsidization of
governmental payers and uncompensated care, regional staffing costs, services
specialization, and operational cost structures and capital expenses that
comprise a hospital's charge structure;
(7) "Patient
variation," any of several factors, including age, preexisting condition,
comorbidity, reaction to medication or treatment, and time of recovery that
influences treatment decisions and affects resource consumption; and
(8) "SDAHO," the
South Dakota Association of Healthcare Organizations.
Source:
32 SDR 69, effective November 7, 2005; 34 SDR 88, effective September 10, 2007;
35 SDR 183, effective February 2, 2009.
General Authority: SDCL 34-12E-11.
Law
Implemented: SDCL 34-12E-11.
