SECTION .2100 – TRANSPARENCY IN HEALTH CARE COSTS

 

10A NCAC 13B .2101       definitions

In addition to the terms defined in G.S. 131E-214.13, the

following terms shall apply throughout this Section, unless text indicates to

the contrary:

(1)           "Current Procedural Terminology (CPT)"

means a medical code set developed by the American Medical Association.

(2)           "Diagnostic related group (DRG)" means a

system to classify hospital cases assigned by a grouper program based on ICD

(International Classification of Diseases) diagnoses, procedures, patient's

age, sex, discharge status, and the presence of complications or

co-morbidities.

(3)           "Department" means the North Carolina

Department of Health and Human Services.

(4)           "Financial assistance" means a policy,

including charity care, describing how the organization will provide assistance

at its hospital(s) and any other facilities. Financial assistance includes free

or discounted health services provided to persons who meet the organization's

criteria for financial assistance and are unable to pay for all or a portion of

the services.  Financial assistance does not include:

(a)           bad debt;

(b)           uncollectable charges that the organization

recorded as revenue but wrote off due to a patient's failure to pay;

(c)           the cost of providing such care to the

patients in Sub-Item (4)(b) of this Rule; or

(d)           the difference between the cost of care

provided under Medicare or other government programs, and the revenue derived

therefrom.

(5)           "Healthcare Common Procedure Coding System

(HCPCS)" means a three-tiered medical code set consisting of Level I, II

and III services and contains the CPT code set in Level I.

 

History Note:        Authority G.S. 131E-214.13;

Temporary Adoption Eff. December 31, 2014;

Eff. September 30, 2015.