RHIT Study Set
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124 terms
Terms | Definitions |
|---|---|
 information systems | 1.a collection of related components that interact to perform a task 2.integration of several elements of a business process to affect a specific outcome 3. a process that refines raw facts into meaningful info 4. provides opportunities to internal operations, improve parent delivery. |
| capital budget | planned outlays for long lived assets to help generate income or support operations over a # or years. |
| tumor accession registry 07-0001? | first two numbers is the year |
| Quality Assessment | process of measuring and evaluating service activities to determine the current level of quality |
| Ratio | relationship between two numbers of the same kind |
| Parento Principal | 20% => 80% 20% of problem sources are from 80% of actual effects |
| Ambulatory Care = | NO H&p! |
| LTC-DRG | one amount per group |
| CKD( Kidney disease) | HTN + ? = Casual relationship with combo Code? |
| Crosby | zero defects QA 14 step quality impovemenet process |
| primary use of a medical record | directly informs each individual care |
| operating budget | current expences of running the business |
| hearsay rule | the rule that hearsay is not admissable unless it falls under the hearsay rule: MRs are business records of the providers |
| contractual allowance | what the hospital will receive in payment from the 3rd party payer( aka contractual adjustment) |
| BUS | A type of hardware that controls the flow of commands between the control processor and other components |
| strategic information systems (planning) | - process for the IF priorities with in an organization - process of identifying and prioritizing needs based on goods - w/ intent of ensuring that all technology initives are integrated and aligned within an organized strategic plan |
| server ( like suddenlink) | computer! - that makes it possible to share information resources across a network of client computers |
| fish bone diagram | performance improvement tool -identifying/classifying the root / cause of a problem ( cause & effect diagram) by ISHIKAWA |
| data warehousing | a database that makes it possible to access from multiple databases and combine the results in to A SINGLE query and reporting interface |
| EOA | statement issued TO the insurance company and provider BY the insurance company- explaining the services provided, amount billed, and payment made by the health care plan |
| consent | a means for patients to convey to healthcare provides their implied / OR EXPRESSED permission to : administer care treatment other medical procedures |
| occurance screening | - a risk management techique risk manager reviews the MR of current and discharged hospital inpatients GOAL => identify potentially compensable events |
| remittance advice ( RA) | explanation of PAYMENTS made by the 3rd party payer INSURANCE COMPANIES! |
| Poisoning sequencing | 900 code, adverse effect code(s), Ecode |
| ADA AMERICANS W/ DISABILITIES ACT | JULY 1990 bar discrimination "make reasonable accommodations" |
| LAN Local area network | a system linking together COMPUTER & OTHER ELEMENTS with in a office/building permitting use of software &/or peripherals |
| AST (SGOT) | liver function test |
| BUN ( blood urea nitrogen) | measurement of amount of urea in blood KIDNEY function test |
| AIDS GUIDELINES | 1. ADMIT FOR HIV RELATED CONDITION: 1st - 042 2nd- codes for HIV related condition 2.ADMIT FOR non-HIV RELATED: 1st- code for unrelated 2nd- 042 3rd - HIV related codes *( V08 - asymptomatic / 795.71 inconclusive test)* |
| justice | ethical concept the obligation to be FAIR to all people ENCOMPASSES ideas of: { fairness } { honesty } { impartiality } |
| beneficence | ethical concept the obligation to do GOOD in all circumstances meaning the qualities { kindness } { Mercy } { charity } |
| CMI (case mix index) | DRG weight / divided by / # of patient cases |
| nolan's 6 stage theory | an institution is at acertain maturity level in information technology at any given time initiation expansion control integration data administration maturity |
| hardware | physical components of computers |
| schema / subschema | schema is the WHOLE database subschema is use one users PART of the database |
| software | instructions with in a computer system OS software APPS |
| privacy (PERSON) | freedom from unauthorized intrustion the right of the patient to control / disclose personal information " right to be left alone" |
| data precision | data have the VALUES they are EXPECTED to have |
| security ( data, info,MR...) | control access and protect information from DISCLOSURE to unauthorized persons physican PROTECTION of facilites and equipment maintain INTEGRITY control access |
| DATA relevancy | the extent to which healthcare related data are useful for the purpose for when it is collected |
| clinical support decision support ( tool ) { CDS } | individual elements are represented in the computer by a special code and are used to make - comparisons - trend analysis' -clinical reminders and alerts |
| institutional use | 3RD PARTY PAYER |
| procedure | steps taken to implement a POLICY |
| policy | governing principals that describe how a department ( or organization) is suppose to handle a specific situation |
| ACOS ( American College of Surgeons) | 1918 improve quality of surgical care by setting high standards for surgical education and practice |
| OASIS ( outcome and assessment infor sets) | home health services under medicare/caid |
| medical staff by laws | guidelines adopted by hospitals med staff to govern business conduct and rights and responsiblities of the members |
| EOB | INSURANCE summary notice AFTER billing procedures/ visit |
| HEDIS | NCQA -performance measures -provide purchasers and consumers with info they need to compare MANAGED CARE PLANS |
| data conversion | the task of moving data from one data structure to another. (usually@ the time of new system install) |
| serial serial - unit | serial- patient is assigned a different # every admission serialUNIT - patient is assigned a different # every admission BUT the records are filled under LAST # assigned |
| RFP (request for proposal) | asking for specific product and contact info often sent to a new list of vendors during design stage |
| board of directors | ultimately responsible of operations |
| accountability | the leader must accept failures as well as success of team members |
| responsibility | duty that the leader accepts in making sure taht the goal os the team in accomplished |
| authority | give the leader the right to make decisions |
| fair labor standards act (FLSA)` | the federal legislation that sets the minimum wage and overtime payment regualtions |
| confidentiality | legal and ethical concept providers responmsibility for protecting health records and other personal information from UNAUTHORIZED DISCLOSURE!A |
| unit testing (data capture) | the testing step in EHR implementation that ensures each data element is captured recorded processed |
| application controls | security strategies password management included in software (APPS) |
| administrative controls | policies that address the management of computer resources |
| push technology | can be an alert active computer technology that sends (PUSHS) info directly to the end user as info become available |
| MIS (management Information Systems) | provides information to healthcare organization managers for use in making decisions that effect a variety of DAY -to DAY activities |
| DSS (decision support system) | gathers data from various sources and assists in providing structure to the data by using various analytical models and visual tools on order to facilitate and improve ULTIMATE OUTCOME in decision making |
| access controls | 1computer software that prevent UN authorized use of information resources 2the process ( designing, implementing, monitoring) a system for guaranteeing that only individuals with a "NEED TO KNOW" are able to view data |
| accounts receivables ( A/R) | records of payments OWED to the organization...by entities ( ex 3rd party payers, patients) HAVE NOT BEEN PAID YET |
| data definition | the specific meaning of healthcare related data element |
| healthcare quality IMPROVEMENT program | IMPROVING medicare beneficiaries |
| SIX SIGMA | 1986 - welch management strategy improve quality of process outputs by identifying / removing cause of defects 99.99966% free of defects |
| public law | right and duties between gov't and private parties OR 2 agencies of gov't |
| private law | a law that regulates conflict between people and private businesses |
| reimbursement | repayment of healthcare services |
| 2 years | Clinical privileges are granted to the physician for an interval >>> specified in the medical staff bylaws, but not longer than |
| NOT found in Charge description master | ICD-9-CM code |
| Primary key | ----------------uniquely identifies each row in a table and ensures that it is unique. |
| Foreign key | this links a second table back to the first table with the primary key |
| The Health Insurance Portability and Accountability Act (HIPAA) | providers federal floor for healthcare |
| Medicare Summary Notice | clarify which services were provided, amount billed, and amount of payments made by the health plan |
| What was the main result of the publication of the Flexner report? | Medical school standards were established |
| each HCPCS/CPT code contains three (3), (RBRVS) | physician work, practice expense malpractice insurance expense |
| Under APCs, payment status indicator "S" means | significant procedure, non-discounted |
| New CPT codes come out | January of each year |
| *source oriented health record | (paper record) - a system of health record organization in which information is arranged according to the patient care department that provided the care (most likely found in acute care) |
| *problem oriented health record | (paper record) - patient record in which clinical problems are defined and documented individually (usually used in outpatient settings, nursing homes, ...) |
| *integrated health record | (paper record) - a system it health record organization in which all the paper forms are arranged in strict chronological order and mixed with forms created by different departments. |
| "hard coding" | HCPCS/CPT codes that appear in the hospital's Chargemaster and will be included automatically on the patient's bill |
| Medicare Part D | assists in prescription coverage |
| Medigap | this is a plan that offers supplemental medicare coverage |
| Medicare Part A | covers inpatient, home healthcare and hospice |
| Medicare Advantage part C | this type of medicare requires patients to use specific hospitals and doctors to get full benefits |
| quality assurance | group of activities designed to measure the quality of service, product, or process with the intention to maintain the desired standard. |
| quality assessment | process of measuring and evaluating service activities to determine the current level of quality |
| quality control | group of actives designed to detect and recognize positive and negative variances with the existing performance to ensure predictable outcomes. |
| quality improvement | methods/ activities designed for the purpose of increasing the quality of service product |
| quality management | the process of coordinating all quality activities |
| sentinel event | unexpected occurrance involving death or serious physical/mental injury to a patient |
| root cause analysis | process for identifying the basic or causative factor that underlies variation on performance |
| [ Brackets ] | enclose synomns alternate wording explanatory phrases |
| ( parenthesis ) | supplemental words that may/MAYNOT be present |
| { braces } | encloses a series of terms each modifies by statement |
| Colon : | used in tabular list after incomplete term meaning |
| subclassification | 5 digit and mos specific codes |
| subcategory | 4 digit codes |
| category | 3 digit code #s |
| nominal data | NAMED data |
| ordinal data | ranked in ORDER data |
| discrete data | represents a distinct and separete value |
| continuous data | has infinate # as a possible value |
| supervisory management | daily EVERYDAY tasks |
| middle management | monitor ongoing OPERATION plans |
| executive management | focuses on the future strategies |
| systems thinking | objective way of looking at work related ideas and processes |
| MDS | minimum data set used for LTC CMS requires that nursing facilities to conduct a comprehensive, accurate, standardized, assessment of each residents functional capacity. |
| LTC | = nursing home and grandma always has RUG |
| preauthorization | the prospective approval of health care based on medical necessity |
| coding residual effects | 1st code late effect followed by THE CAUSE of the late effect |
| methods for determining provider FEES | 1- charge based fee 2- resource based fee STRUCTURE |
| WORKERS COMP | must be filed after 95th day after date of service |
| modifier -91 may not be used ... | when tests are RERUN |
| accreditation | means that standards are met BEYOND that set out by law |
| qualitative analysis | reviewing patient record for inaccurate documentation |
| CoP | Interprets the laws |
| modifier -26 | ... |
| q3014/ HCPCS code | tele-health |
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