Immediate medical services for the examination, diagnosis, care, and treatment of a patient because of severe episodes of illness. Usually, acute care is given in a hospital by specialized personnel and use of sophisticated technical equipment. It may be intensive care, critical care, or emergency care.

Sickness that is usually of short-term duration and that often comes on quickly.

Organization formed to protect patient access to quality long-term hospital care; formerly known as Long Term Acute Care Hospital Association of America (LTACHA). Long Term Acute Care Hospitals (LTACHs) are hospitals that provide patients with acute care for extended inpatient stays (defined by federal statute as an average of 25 days or more). ALTHA works to protect the rights of medically complex patients and the hospitals that treat them by educating federal and state regulators, members of Congress, and health care industry colleagues. ALTHA also works to increase quality of care by sharing and improving best practices among its hospital members.

Procedural code in the CPT book that is preceded with a plus (+) symbol indicating the code may be reported in addition to the parent or primary procedure code number (see Box A-1 ). Add-on codes are never reported for stand-alone services but are reported secondarily in addition to the primary procedure.Box A-1ADD-ON CODEParent code 11000Biopsy of skin … single lesion each separate/additional lesion (list separately in addition to code for primary procedure)Add-on code +11101

Individual who becomes insured after the effective date of a group insurance policy.

Health care services not covered by Medicare and reductions in premiums or cost sharing for Medicare-covered services. Additional benefits are specified by the Medicare Advantage (MA) Organization and are offered to Medicare beneficiaries at no additional premium. Those benefits must be at least equal in value to the adjusted excess amount calculated in the adjusted or average community rate (ACR). An excess amount is created when the average payment rate exceeds the adjusted community rate (as reduced by the actuarial value of coinsurance, copayments, and deductibles under Parts A and B of Medicare). The excess amount is then adjusted for any contributions to a stabilization fund. The remainder is the adjusted excess, which is used to pay for services not covered by Medicare and/or is used to reduce charges otherwise allowed for Medicare-covered services. Additional benefits can be subject to cost sharing by plan enrollees. Additional benefits can also be different for each MA plan offered to Medicare beneficiaries.

Form issued by a Medicare administrative contractor (MAC) to a provider asking for more information in a patient’s medical record so that coverage, coding, and payment determination can be made concerning a claim.