Resources
Glossary
Discharge planning has its own vocabulary, and the same word can mean different things to clinical, finance and IT teams.
A
ADT feed admit, discharge, transfer
An HL7 version 2 message stream that tells other systems when a patient is admitted, transferred or discharged. Aurifex uses it to know the moment a patient arrives, moves or leaves.
How it fits in EpicAM-PAC 6-Clicks
A short mobility and daily-activity score that physical and occupational therapists record in the hospital. Higher scores mean more independence, and the scores help predict the right next place of care.
Anticipated disposition
Where a patient is expected to go after the hospital: home or self-care, home health, a skilled nursing facility, an inpatient rehabilitation facility or a long-term acute care hospital.
Discharge date predictionAvoidable day
A day a patient stays in the hospital after they no longer need hospital care, because something outside their condition is holding them, such as a bed offer, an authorization or equipment. Each avoidable day is tracked with a reason code.
Unit capacity and barriersB
Business associate agreement BAA
A contract required by HIPAA between a hospital and a vendor that handles protected health information. Aurifex signs one with each hospital before any patient data is shared.
Trust and AI safetyC
Case-mix adjustment
A way to compare stays fairly by accounting for how sick patients are. Aurifex compares each stay with its expected length of stay from the DRG GMLOS, so a sicker or healthier group of patients doesn't flatter or hide a result.
Evaluation resultsCMS-13 conditions the 60 percent rule
The conditions Medicare counts toward an inpatient rehabilitation facility's compliance threshold. At least 60 percent of an IRF's patients must have one, such as stroke, spinal cord injury, brain injury, hip fracture, major multiple trauma, amputation, burns, certain neurological and arthritic conditions, or a joint replacement that is bilateral, in a patient with a BMI of 50 or more, or in a patient 85 or older.
Inpatient rehab referralsCode status
A patient's documented wishes about resuscitation, such as full code or do not resuscitate. It's one of the critical fields checked before a referral packet can be sent.
D
DRG Medicare Severity Diagnosis Related Group, MS-DRG
The group Medicare uses to pay for an inpatient stay, based on diagnoses and procedures. During the stay, the working DRG sets the expected length of stay.
E
End-of-pilot review readout
The planned meeting at the end of a pilot, usually week 20, where case-mix-adjusted results are presented against the hospital's own baseline, with counts, baselines and the method attached, and the hospital decides whether to expand. Some teams call it the readout.
How a pilot worksExpected discharge date EDD
The day a patient is expected to be ready to leave. The clinician-set EDD is the date of record. Aurifex shows its model EDD beside it and never overwrites it.
Discharge date predictionExcess patient days
Days a patient stays beyond what their condition called for, measured against expected length of stay and adjusted for case mix.
Evaluation resultsF
FHIR R4
Fast Healthcare Interoperability Resources, release 4. The standard API that EHRs, including Epic, use to share data such as encounters, conditions, observations, medications and notes with approved applications.
How it fits in EpicG
GMLOS geometric mean length of stay
The typical length of stay for a DRG, published by CMS. It's the benchmark behind the length-of-stay index and case-mix adjustment.
H
Hallucination rate per statement
The share of statements in AI drafts that the cited source doesn't support. Aurifex requires a citation for every clinical sentence, and clinicians review samples to measure how often unsupported statements still appear.
Trust and AI safetyI
Important Message from Medicare IM notice
A notice hospitals give Medicare patients about their discharge rights, within two days of admission and again before discharge.
In Basket
The Epic inbox where clinicians receive messages, results and tasks. Aurifex places sampled drafts for clinician review in an In Basket-style review folder.
Inpatient rehabilitation facility IRF, acute inpatient rehab
A hospital or hospital unit that provides intensive, physician-supervised rehabilitation, usually at least 3 hours of therapy a day. Patients must meet CMS criteria to be admitted.
Inpatient rehab referralsIRF admission criteria
The Medicare requirements for IRF care: active therapy from two or more disciplines with one of them PT or OT, the ability to take part in an intensive program, an expectation of measurable improvement, supervision by a rehabilitation physician with face-to-face visits at least 3 days a week, and the need for an intensive, coordinated team approach.
Inpatient rehab referralsL
Length of stay LOS
The number of days from admission to discharge. The length-of-stay index divides observed stay by expected stay, so 1.00 means as expected for the case mix and lower is shorter.
LTACH long-term acute care hospital
A hospital for patients who need hospital-level care for an extended time, such as prolonged ventilator weaning.
M
Medicare Advantage prior authorization
Approval a Medicare Advantage plan requires before it covers a post-acute stay. Traditional Medicare doesn't require it for IRF admission. Aurifex blocks sending until the case manager acknowledges this step.
Inpatient rehab referralsP
Patient choice list
The list of available post-acute providers that hospitals must offer patients under the CMS discharge planning rules in 42 CFR 482.43, including quality data where available.
PM&R physical medicine and rehabilitation, physiatry
The medical specialty focused on restoring function. A PM&R physician, or physiatrist, often evaluates whether a patient is a good candidate for an IRF.
Pre-admission screening
The IRF's own review of a referred patient, required for Medicare within the 48 hours before admission. The IRF's admissions liaison usually completes it.
R
Readout
Another name for the end-of-pilot review: the planned meeting at the end of a pilot where results are presented against the hospital's own baseline and the hospital decides whether to expand.
How a pilot worksS
Section GG
The standard items Medicare post-acute assessments use to rate self-care and mobility, such as walking, transfers and eating, on a six-point scale from dependent to independent. It replaced the FIM in IRF assessments in 2019.
Silent mode
A pilot phase where Aurifex runs on live data but shows nothing to clinicians. Its predictions and drafts are compared with what actually happened before go-live.
How a pilot worksSNF skilled nursing facility
A facility that provides daily skilled nursing or therapy after a hospital stay, at a lower intensity than an IRF.
T
Three-hour rule
The expectation that an IRF patient can take part in therapy for generally at least 3 hours a day, at least 5 days a week, or at least 15 hours over 7 days when that's documented.
Inpatient rehab referralsW
Worklist
A sortable list of patients in Epic that a case manager or unit uses to plan the day. Aurifex adds its columns, such as the model expected discharge date and the Possible IRF flag, to the case-management worklist.
See Aurifex on your own discharge workflow
We'll walk through your worklist, a drafted referral and how a pilot would be measured on your units.