ARSD 67:16:03:01. Definitions

Terms used in this chapter mean: (1) "Cost outlier," a hospital claim that the department determines has an estimated cost greater than the diagnosis-related group base payment plus the fixed loss threshold published on the department's fee schedule website; (2) "Diagnosis-related group," a classification assigned to an inpatient hospital service claim using the All Patient Refined Diagnosis Related Groups classification methodology; (3) "Emergency hospital care," the hospital care necessary to prevent the death or serious impairment of the health of the recipient after the sudden onset of a medical condition that is manifested by symptoms of sufficient severity to be life-threatening or require immediate medical intervention; (4) "Hospital services," items and services provided on the hospital's premises to a patient by a hospital under the direction of a physician or a dentist; (5) "Inpatient," a patient who has been admitted to a hospital on the recommendation of a physician or a dentist; and (6) "Outpatient," a patient who receives professional services at a hospital, but is not provided with room, board, and services on a twenty-four-hour basis.