S.D. Admin. R. 44:66:01:01

Current through Register Vol. 51, page 71, January 6, 2025

Section 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.

S.D. Admin. R. 44:66:01:01

32 SDR 69, effective 11/7/2005; 34 SDR 88, effective 9/10/2007; 35 SDR 183, effective 2/2/2009.

General Authority: SDCL 34-12E-11.

Law Implemented: SDCL 34-12E-11.