Additional procedures completed during the same surgical session.

Provision of similar services (e.g., hospital visits) to the same patient by more than one physician on the same day. Usually there is the presence of a separate physical disorder, but it is possible they may be providing care for the same diagnosis on the same day. When concurrent care is provided, the diagnosis must reflect the medical necessity of different specialties. Also called concurrent medical care.

Process in which employees trained in coding work directly on the hospital inpatient units and code medical care as it happens.

Disorder that coexists with the primary condition, complicating the treatment and management of the primary disorder. It may alter the course of treatment required or lengthen the expected recovery time of the primary condition. It is also referred to as comorbidity or comorbidity condition.

Assessment and review that occurs at the time reimbursements are posted to financial records to evaluate the accuracy of payments received on the day of the audit.

Evaluation of health care services to determine medical necessity and appropriateness of medical care during the time the services are being provided. It is done to encourage discharge of the patient from the hospital as soon as his or her medical condition no longer needs continued inpatient care. This may occur for inpatient, residential, partial hospitalization treatment, and outpatient care. The review is usually done at the time services are provided by a health care provider other than the one giving the care.
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A case management technique which allows insurers to monitor an insured’s hospital stay and to know in advance if there are any changes in the expected period of confinement and the planned release date.

Wide-ranging sets of similar diseases clinically and cost comparable under the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) Model for capitated payments to managed care organizations.

Two-digit numeric code inserted in Fields 18 through 28 on the Uniform Bill (UB-04) insurance claim form to show that a condition applies and affects payment of the claim. Condition codes denote if coverage exists under another insurance, the illness or injury is employment related, the bill is an outlier, or medical necessity affects room assignment.

Insurance agreement in which the insured’s acceptance is considered uncertain during a specific time period and during which time the individual may cancel the agreement and receive a refund of the premium payments.
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Although only the Insurer can be forced to perform after the contract after the contract is effective, the Insurer can refuse to perform if the insured does not satisfy certain conditions contained in the contract. As such, Insurance contracts are conditional contracts.