Diagnosis present at the time of the inpatient admission. It can include conditions known at the time of admission, present at admission but not diagnosed until later, and conditions that develop during outpatient encounters such as emergency department, observation, or outpatient surgery. Also see present-on-admission (POA) indicator.

Interest rate factor for determining the present value of a sum in the future. A formula is used to obtain this number.

Code, eighth digit, that is attached to the diagnostic code required for reporting Medicare inpatients’ claims for specific types of conditions. It is to be reported on the UB-04 claim form in diagnostic coding fields 67 and 67A-Q. For electronically transmitted claims, the POA is reported in loop 2300, data element H101, which should contain the letters “POA” followed by the assigned value for the code. Also see present on admission (POA).

Reason for the patient’s office visit such as complaints, condition, disease, findings, illness, injury, signs, or symptoms.

Appeal by a physician to a third-party payer for medical services not yet provided to the patient. Also see appeal, postservice appeal, and expedited appeal.

Legal assumption that a fact exists.

Assumption of total disability when an insured is considered totally disabled (blindness, loss of hearing, speech, or limbs). The insurance company may pay a lump sum in addition to monthly payments for a maximum benefit period.
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A disability involving loss of sight, hearing, speech or any two limbs, which is presumed to be a permanent and total disability. In such cases, the insurer does not require the insured to submit to periodic medical examinations to prove continuing disability.

A federal/state program designed to ease access to prenatal care offering immediate temporary coverage to low-income women pending a formal Medi-Cal application.

Possible biological father of a child but not necessarily the legal parent or the confirmed father. Also referred to as alleged father.