Clinical

The insurance policy identifier linked to the member's coverage at the time of an unplanned hospital readmission. Used in claims processing to validate coverage eligibility, coordinate benefits, and route readmission-related charges to the correct payer for adjudication.

The patient's chosen or commonly used name recorded at the time of an unplanned hospital readmission. Used in patient engagement, communication workflows, and care transition documentation to ensure accurate and respectful identification across post-discharge follow-up interactions.

The billed, allowed, or paid cost amount associated with an unplanned hospital readmission claim. Used in financial analytics, contract performance reviews, and value-based care programs to assess the economic impact of avoidable readmissions on payers and health systems.

A flag identifying whether a hospital return encounter is classified as the primary or index readmission event within a patient's episode of care. Used in quality measurement and claims analysis to distinguish principal readmissions from secondary or subsequent return hospitalizations.

A ranking or urgency classification assigned to a patient's unplanned hospital readmission to guide care management intervention sequencing. Higher priority designations typically reflect complex clinical conditions, high readmission risk scores, or payer program requirements for expedited outreach.

The calendar date on which a clinical procedure was performed during an unplanned hospital readmission encounter. Used in claims processing, clinical documentation, and quality measurement to sequence care events and establish procedure-level timelines within the readmission episode.

The patient's recorded heart rate, measured in beats per minute, captured at the time of an unplanned hospital readmission. Used as a clinical vital sign to assess patient acuity, guide triage decisions, and document physiological status upon return hospitalization intake.

The numeric count of unplanned hospital readmission events recorded for a patient, population cohort, or facility within a specified reporting period. Used in quality metrics, utilization management, and value-based care analytics to track readmission volume and trend patterns.

The patient's self-reported or recorded racial classification captured at the time of an unplanned hospital readmission. Used in health equity reporting and social determinants analysis to identify disparities in readmission rates across demographic groups and target intervention programs.

The minimum and maximum boundary values defining acceptable or observed readmission metrics, such as rate thresholds or risk score intervals, within a quality reporting framework. Used in performance benchmarking to flag outlier facilities or populations exceeding established readmission targets.

The percentage of patients discharged from a hospital who are readmitted within 30 days of discharge. A critical quality metric used in CMS Hospital Readmissions Reduction Program which penalizes hospitals with excessive readmission rates for conditions including heart failure, pneumonia, and hip and knee replacement.

A scored or graded assessment reflecting the severity, risk level, or quality performance associated with an unplanned hospital readmission. Used in value-based purchasing programs, hospital star ratings, and care management prioritization to evaluate and compare readmission outcomes.

The proportional comparison of observed unplanned hospital readmissions to expected readmissions within a defined patient population, often risk-adjusted. Used in CMS Hospital Readmissions Reduction Program reporting and payer scorecards to benchmark facility performance against national standards.

The documented clinical or administrative explanation for why a patient returned to inpatient hospitalization within the readmission window following discharge. Used in root cause analysis, care gap identification, and quality improvement initiatives to address preventable return admission drivers.

The date on which a readmission claim, referral, or notification was received by the payer, care management team, or health system. Used in claims adjudication workflows and utilization management to track submission timeliness and measure processing lag for readmission-related transactions.

External identifier or cross-reference linking a readmission event to related records such as the index admission, care management case, or prior encounter. Used in hospital readmission tracking systems to establish relationships between inpatient stays occurring within 30 or 90 days of discharge.

Date on which the clinical condition or care management issue that triggered the readmission was considered resolved. Used in inpatient quality tracking to measure length of active readmission episodes and evaluate effectiveness of interventions initiated during the return hospitalization.

Respiratory rate in breaths per minute recorded during the readmission encounter, typically captured at triage or admission assessment. Used in clinical deterioration monitoring and risk stratification to identify patients requiring escalated care during a return inpatient stay within 30 days of prior discharge.

Documented clinical outcome or finding associated with a diagnostic test, procedure, or intervention performed during a readmission encounter. Used in inpatient quality analytics to evaluate patient response to treatment and determine whether the return hospitalization achieved the intended clinical objective.

Documents the body systems assessed during clinical review of an unplanned hospital return within 30 days of discharge. Captures organ systems evaluated to determine whether the readmission was related to the initial inpatient stay, supporting quality metrics and care gap analysis.