Ariz. Admin. Code § 9-11-101

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-11-101 - Definitions

In this Chapter, unless otherwise specified:

1. "Admission" or "admitted" means documented acceptance by a health care institution of an individual as an inpatient of a hospital, a resident of a nursing care institution, or a patient of a hospice.

2. "AHCCCS" means the Arizona Health Care Cost Containment System, established under A.R.S. § 36-2902.

3. "Allowance" means a charity care discount, self-pay discount, or contractual adjustment.

4. "Arizona facility ID" means a unique code assigned to a hospital by the Department to identify the source of inpatient discharge or emergency department discharge information.

5. "Assisted living facility" means the same as in A.R.S. § 36-401.

6. "Attending provider" means the medical practitioner who has primary responsibility for the services a patient receives during an episode of care.

7. "Available bed" means an inpatient bed or resident bed, as defined in A.R.S. § 36-401, for which a hospital, nursing care institution, or hospice has health professionals and commodities to provide services to a patient or resident.

8. "Bill" means a statement for money owed to a health care institution for the provision of the health care institution's services.

9. "Business day" means any day of the week other than a Saturday, a Sunday, a legal holiday, or a day on which the Department is authorized or obligated by law or executive order to close.

10. "Calendar day" means any day of the week, including a Saturday or a Sunday.

11. "Cardiopulmonary resuscitation" means the same as in A.R.S. § 36-3251.

12. "Charge" means a specific dollar amount set by a health care institution for the use or consumption of a unit of service provided by the health care institution.

13. "Charge source" means the unit within a health care institution that provided services to an individual for which the individual's payer source is billed.

14. "Charity care" means services provided without charge to an individual who meets certain financial criteria established by a health care institution.

15. "Chief administrative officer" means the same as in A.A.C. R9-10-101.

16. "Chief financial officer" means an individual who is responsible for the financial records of a health care institution.

17. "Classification" means a designation that indicates the types of services a hospital provides.

18. "Clinical evaluation" means an examination performed by a medical practitioner on the body of an individual for the presence of disease or injury to the body, and review of any laboratory test results for the individual.

19. "Code" means a single number or letter, a set of numbers or letters, or a combination of numbers and letters that represents specific information.

20. "Commodity" means a non-reusable material, such as a syringe, bandage, or IV bag, utilized by a patient or resident.

21. "Contractual adjustment" means the difference between charges billed to a payer source and the amount that is paid to a health care institution based on an established agreement between the health care institution and the payer source.

22. "Control number" means a unique number assigned by a hospital for an individual's specific episode of care.

23. "Department" means the Arizona Department of Health Services.

24. "Designee" means a person assigned by the governing authority of a health care institution or by an individual acting on behalf of the governing authority to gather information for or report information to the Department.

25. "Diagnosis" means the identification of a disease or injury, by an individual authorized by law to make the identification, that is a cause of an individual's current medical condition.

26. "Discharge" means a health care institution's termination of services to a patient or resident for a specific episode of care.

27. "Discharge status" means the disposition of a patient, including whether the patient:

a. Was discharged home,

b. Was transferred to another health care institution, or

c. Died.

28. "DNR" means Do Not Resuscitate, a document prepared for a patient indicating that cardiopulmonary resuscitation is not to be used in the event that the patient's heart stops beating.

29. "Electronic" means the same as in A.R.S. § 36-301.

30. "Emergency" means the same as in A.A.C. R9-10-101.

31. "Emergency department" means the unit within a hospital that is designed for the provision of emergency services.

32. "Emergency services" means the same as in A.A.C. R9-10-101.

33. "Episode of care" means medical services, nursing services, or health-related services provided by a hospital to a patient for a specific period of time, ending with a discharge.

34. "Fiscal year" means a consecutive 12-month period established by a health care institution for accounting, planning, or tax purposes.

35. "Governing authority" means the same as in A.R.S. § 36-401.

36. "Health care institution" means the same as in A.R.S. § 36-401.

37. "Health-related services" means the same as in A.R.S. § 36-401.

38. "Home health agency" means the same as in A.R.S. § 36-151.

39. "Home health services" means the same as in A.R.S. § 36-151.

40. "Home office" means the person that is the owner of and controls the functioning of a nursing care institution.

41. "Hospice" means the same as in A.R.S. § 36-401.

42. "Hospital" means the same as in A.A.C. R9-10-101.

43. "Hospital administrator" means the same as "chief administrative officer" or "administrator" in A.A.C. R9-10-101.

44. "Hospital services" means the same as in A.A.C. R9-10-201.

45. "Inpatient" means an individual admitted to a hospital and billed as an inpatient according to the hospital's policies and procedures.

46. "International Classification of Diseases Code" means a code included in a set of codes such as the ICD-10-CM codes, which is used by a hospital for billing purposes.

47. "Licensed capacity" means the same as in A.R.S. § 36-401.

48. "Management company" means an entity that:

a. Acts as an intermediary between the governing authority of a nursing care institution and the individuals who work in the nursing care institution,

b. Takes direction from the governing authority of the nursing care institution, and

c. Ensures that the directives of the governing authority of the nursing care institution are carried out.

49. "Medical practitioner" means an individual who is:

a. Licensed:

i. As a physician;

ii. As a dentist, under A.R.S. Title 32, Chapter 11, Article 2;

iii. As a podiatrist, under A.R.S. Title 32, Chapter 7;

iv. As a registered nurse practitioner, under A.R.S. Title 32, Chapter 15;

v. As a physician assistant, under A.R.S. Title 32, Chapter 25; or

vi. To use or prescribe drugs or devices for the evaluation, diagnosis, prevention, or treatment of illness, disease, or injury in human beings in this state; or

b. Licensed in another state and authorized by law to use or prescribe drugs or devices for the evaluation, diagnosis, prevention, or treatment of illness, disease, or injury in human beings in this state.

50. "Medical record number" means a unique number assigned by a hospital to an individual for identification purposes.

51. "Medical services" means the same as in A.R.S. § 36-401.

52. "Medicare" means a federal health insurance program established under Title XVIII of the Social Security Act.

53. "National provider identifier" means the unique number assigned by the Centers for Medicare and Medicaid Services to a health care institution, physician, registered nurse practitioner, or other medical practitioner to submit claims and transmit electronic health information to all payer sources.

54. "Newborn" means a human:

a. Whose birth took place in the reporting hospital, or

b. Who was:

i. Born outside a hospital,

ii. Admitted to the reporting hospital within 24 hours of birth, and

iii. Admitted to the reporting hospital before being admitted to any other hospital.

55. "Nursing care institution" means the same as in A.R.S. § 36-446.

56. "Nursing care institution administrator" means the same as in A.R.S. § 36-446.

57. "Nursing services" means the same as in A.R.S. § 36-401.

58. "Patient" means the same as in A.A.C. R9-10-101.

59. "Payer source" means an individual or an entity, such as a private insurance company, AHCCCS, or Medicare, to which a health care institution sends a bill for the services provided to an individual by the health care institution.

60. "Physician" means an individual licensed as a doctor of allopathic medicine under A.R.S. Title 32, Chapter 13, as a doctor of naturopathic medicine under A.R.S. Title 32, Chapter 14, or as a doctor of osteopathic medicine under A.R.S. Title 32, Chapter 17.

61. "Principal diagnosis" means the reason established after a clinical evaluation of a patient to be chiefly responsible for a specific episode of care.

62. "Principal procedure" means the procedure judged by an individual working on behalf of a hospital to be:

a. The most significant procedure performed during an episode of care, or

b. The procedure most closely associated with a patient's principal diagnosis.

63. "Priority of visit" means the urgency with which a patient required medical services during an episode of care.

64. "Procedure" means a set of activities performed on a patient that:

a. Is intended to diagnose or treat a disease, illness, or injury;

b. Requires the individual performing the set of activities be trained in the set of activities; and

c. May be invasive in nature or involve a risk to the patient from the activities themselves or from anesthesia.

65. "Prospective payment system" means a system of classifying episodes of care for billing and reimbursement purposes, based on factors such as diagnoses, age, and sex.

66. "Refer" means to direct an individual to a health care institution for services provided by the health care institution.

67. "Referral source" means a code designating the entity that referred or transferred a patient to a hospital.

68. "Registered nurse practitioner" means an individual who meets the definition of registered nurse practitioner in A.R.S. § 321601, and is licensed under A.R.S. Title 32, Chapter 15.

69. "Reporting period" means the specific fiscal year, calendar year, or portion of the fiscal or calendar year for which a health care institution is reporting data to the Department.

70. "Residence" means the place where an individual lives, such as:

a. A private home,

b. A nursing care institution, or

c. An assisted living facility.

71. "Resident" means the same as in A.A.C. R9-10-101.

72. "Revenue code" means a code for a unit of service that a hospital includes on a bill for hospital services.

73. "Secondary diagnosis" means any diagnosis for an individual other than the principal diagnosis.

74. "Self-pay discount" means a reduction in charges billed to an individual.

75. "Service" means an activity performed as part of medical services, hospital services, nursing services, emergency services, health-related services, hospice services, home health services, or supportive services.

76. "Supportive services" means the same as in A.R.S. § 36-151.

77. "Transfer" means discharging an individual from a health care institution so the individual may be admitted to another health care institution.

78. "Trauma center" means the same as in:

a. A.R.S. § 36-2201, or

b. A.R.S. § 36-2225.

79. "Treatment" means the same as in A.A.C. R9-10-101.

80. "Type of" means a specific subcategory of the following that is provided, enumerated, or utilized by a health care institution:

a. An employee or contracted worker;

b. An accounting concept, such as asset, liability, or revenue;

c. A non-covered ancillary charge;

d. A payer source;

e. A charge source;

f. A medical condition; or

g. A service.

81. "Type of bed" means a category of available bed that specifies the services provided to an individual occupying the available bed.

82. "Unit" means an area within a health care institution that is designated by the health care institution to provide a specific type of service.

83. "Unit of service" means a procedure, service, commodity, or other item or group of items provided to a patient or resident for which a health care institution bills a payer source a specific amount.

84. "Written notice" means a document that is provided:

a. In person,

b. By delivery service,

c. By facsimile transmission,

d. By electronic mail, or

e. By mail.

Ariz. Admin. Code § R9-11-101

Section repealed, new Section adopted effective June 25, 1993, through an exemption from A.R.S. Title 41, Chapter 6 pursuant to Laws 1992, Ch. 197, §2; received in the Office of the Secretary of State June 10, 1993 (Supp. 93-2). Amended by final rulemaking at 13 A.A.R. 3648, effective December 1, 2007 (Supp. 07-4). Amended by final rulemaking at 28 A.A.R. 1481, effective 11/7/2022.