HIM 110 - Final Exam Review

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health information technology (HIT)

The use of computers and electronic communications to manage medical information and its secure exchange is known as

computer skill, knowledge of health care reform, health care skill (all of the above)

For the greatest career opportunities for advancement in health technology, new employees need

practice management program

What type of software program is widely used in the medical office to bill patients and health plans?

20%

The Bureau of Labor Statistics predicts that the field of health informatics will grow by what percent through 2018?

Physician Quality Reporting Initiative (PQRI)

What program gives bonuses to physicians when they use treatment plans and clinical guidelines that are based on scientific evidence?

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

What provides financial incentives for practitioners who use electronic prescribing?

National Health Information Network (NHIN)

What key component of the government's HIT strategy enables a common platform for health information exchange by providing a set of standards, services, and policies that enable the secure exchange of health information over the Internet?

encounter

What is the meeting of a patient with a physician or other medical professional for the purpose of providing health care?

eight

How many data points are included in an ambulatory-care medical record?

all of the above

A medical record may have (the physician's assessment, diagnosis, and treatment plan, the patient's medical history, results of laboratory work)

all of the above

Clinical information may be used for: (legal issues, public health and homeland security, billing and reimbursement)

inaccurate

Payment from a health plan may be denied if clinical information is incomplete or ___________.

medical malpractice

The provision of medical services at a less than acceptable level of professional skill that results in injury or harm to a patient is known as

electronic medical records (EMRs)

What are computerized records of one physician's encounters with a patient over time?

personal health records (PHRs)

What are private, secure electronic files that are created, maintained, and owned by the patient?

practice management programs

The process of autoposting is handled by

less

An electronic funds transfer takes ______ time to put revenue in a bank than does receiving and depositing manual checks.

all of the above

What type of information about the business is entered in a PM? (provider data, transaction data, patient data)

similarly

While medical practices use a number of different practice management (PM) programs, they all usually operate __________.

follow up patient payments and collections

The final step in the medical documentation and billing cycle is to

revenue cycle management (RCM)

Managing the activities associated with a patient encounter to ensure that the provider receives full payment for services is known as

flowing into the practice

Accounts receivable are monies

scheduling and registration

Back office staff handle billing, insurance, and collections; front office staff usually handle

medical assistants (MAs)

__________ perform both administrative and certain clinical tasks in physician offices.

most

Certification is offered in __________ allied health specialties.

lifelong learning

In the health care field, a commitment to ____________ is a key component of success.

all of the above

The migration from paper to electronic records has been slow because of (high cost of EHRs, lack of digital information exchange standards, privacy concerns)

the course of care

Medical records, or charts, are created and shared to help make accurate diagnoses of patients' conditions and to trace

documentation

__________ means organizing a patient's health record in chronological order, using a systematic, logical, and consistent method.

legal documents

Patient medical records are

patient

The term medical professional liability describes this responsibility that __________have.

may be

The documentation of diagnoses and treatments ___________used as proof of billed services.

CMS

The main federal government agency responsible for health care is the

provider

The information in a patient's medical record belongs to the

Acknowledgment

The ___________________ of Receipt of Notice of Privacy Practices states that the patient has read the privacy practices and understands how the provider intends to protect the patient's rights to privacy under HIPAA.

all of the above

PHI can be used and disclosed by providers without the patient's permission in situations involving (treatment, health care operations, payment)

protection of health information on computer networks, the Internet, and electronic storage media

The HIPAA Security rule was enacted specifically to provide guidelines for the

Passwords

____________ are specific codes that are required for gaining access to information on a computer or network.

technical safeguards

__________ are the technology and related policies and procedures used to protect electronic data and control access to it. (administrative safeguards, physical safeguards, technical safeguards)

business associates

Covered entities and their _____________ are responsible for determining whether a breach has occurred to which the notification obligations apply.

60

The HITECH act requires breach notifications to be made no later than _________ calendar days after discovery of the breach under normal circumstances.

five

There are __________ components that must be included in a breach notification.

all of the above

The HIPAA Electronic Health Care Transactions and Code Sets (TCS) standards apply to (electronic formats, code sets, identifiers)

all of the above

Examples of HIPAA standard transactions are ( electronic claims, health plan payments, health plan eligibility inquires/responses)

NPI

The __________ is the standard for the identification of providers when filing claims and other transactions.

HCPCS

The HIPAA code set for specific products, supplies, and services that are not included in the CPT code set is ___________.

not necessarily intentional

Abuse is __________; it may be the result of ignorance of a billing rule or of inaccurate coding.

abuse

In federal law, __________ is an action that misuses money that the government has allocated.

OCR

Enforcing civil violations of HIPAA privacy and security rules is the job of

process

A compliance plan is a __________for finding, correcting, and preventing illegal medical office practices.

all of the above

Compliance plans cover (coding, billing, all areas of government regulation of medical practices)

four

The HIPAA Security Rule requires covered entities to conduct __________ types of audits.

unauthorized

The use of user names and passwords prevents _________ access to the program, safeguards critical patient information, and protects patient confidentiality.

asterisks (*)

As passwords are entered, the characters are replaced with __________ on the screen so there is no chance that someone will see the actual password characters.

Park

The privacy and security feature in MCPR known as __________ allows a user to leave a workstation for a brief time without having to exit the program.

chart

The term __________ refers to a patient's medical record.

menu

On the main MCPR window, the _______bar contains the menus of commands.

Lab Review

Use the _________section of the Dashboard to store items the provider needs to review.

all of the above

The main window in Medisoft Network Professional contains the (title bar, toolbar, menu bar)

all of the above

Physician practices use Medisoft Network Professional to (enter charges, follow up on accounts, create statements)

frequently used menu commands

Buttons on the toolbar located on the Medisoft Network Professional window work as shortcuts for ________.

New Patient button

To enter preregistration information about a new patient in Medisoft Network Professional, click the

none of the above (used for all steps)

Computer software is used for ______the steps in the medical documentation and billing cycle. (only two of, incorrect the first eight of, only the middle four of)

Lists

Demographic information is entered in Medisoft Network Professional in the Patient/Guarantor dialog box, which is accessed via the ________ menu.

SOAP notes

A problem-oriented medical record contains

checks out

The encounter steps include all activities that take place from the time the patient arrives for an office visit until the patient ________.

Problem List

The chief complaint/reason for the visit is recorded in the _______ folder in Medisoft Network Professional.

A task that follows next after the visit and its documentation is _________.

coding

Transaction Entry

Patient payments made at the time of service are entered in the _______ dialog box.

Activities menu

In Medisoft Network Professional, claim functions are located on the

Activities and Reports menus

In Medisoft Network Professional, collection functions are located on the

Claim Management

In Medisoft Network Professional, the _________ dialog box lists current claims.

balances

After payments from health plans have been received, patients are billed for _________.

very similar

The steps required to restore a backup file are __________ to the steps used to back up a file.

Disaster recovery

__________________ refers to an action for resuming normal operations after a situation such as a fire or a computer malfunction.

all of the above

The Medisoft Clinical Help Feature ( provides detailed explanations of program features, offers tips designed to improve user productivity, lists common errors)

knowledge base

The Medisoft Clinical website contains a searchable __________ , which is a collection of up-to-date technical information about Medisoft Clinical products.

first-come, first-served

In urgent care clinics and many walk-in clinics, patients may not have the option of making appointments; instead, they are seen on a _______ basis.

new patient (NP)

A(n) __________ is someone who has not received any services from the provider within the past three years.

preregistration

The process of gathering new patient information before an appointment is known as

participating (PAR) provider

A __________ agrees to provide medical services to a payer's policyholders according to the terms of the plan's contract.

established patient (EP)

When a(n) __________ contacts the office for an appointment, the receptionist verifies that the information on file for the patient is still correct.

eligibility

To establish financial responsibility for insured patients, first verify the patient's

premium

A specified amount of money for a health insurance contract, usually paid monthly, is called a __________.

all of the above

Types of providers include (long-term care facilities, physicians, hospitals)

coinsurance

__________ is the percentage of each claim that the insured pays.

Benefits

________are defined by the Health Insurance Association of America as payments for covered medical services.

Preventive

___________ medical services include annual physical examinations, pediatric and adolescent immunizations, prenatal care, and routine screening procedures such as mammograms.

out-of-pocket; benefits

The phrase __________ means expenses the insured must pay before _______ begin.

Capitation

_____________ is a fixed prepayment to a medical provider for all necessary contracted services provided to each patient who is a plan member.

preferred provider organizations (PPOs)

What is the most popular type of health plan?

all of the above

If the patient's plan is an HMO requiring a primary care provider (PCP), the administrative staff must verify that the (provider is a plan participant, patient is assigned to the primary care physician as of the date of service, patient is listed on the plan's enrollment master list)

percentage

If a plan requires coinsurance, the ______________of coinsurance the patient must pay should be verified.

preauthorization

Managed care plans usually require __________ before a patient sees a specialist, is admitted to the hospital, or has a particular procedure.

referring; referred

A referral number is an authorization number given by a ______physician to the ____________physician.

provider's daily schedule

The __________, shown in the right half of the Office Hours window, is a listing of time slots for a particular day for a specific provider.

Office Hours; Medisoft Network Professional

When a new patient phones the office for an appointment, it can be scheduled in ___________before the patient information is entered in ____________.

Go To a Date

The best way to create follow-up appointments is to use the ________shortcut button on the Office Hours toolbar.

mouse

A quick way to change or delete an appointment is to select the appointment and press the right ________button to display a shortcut menu with options such as Cut, Copy, and Delete.

Medisoft Network Professional

The patient recall feature is located in which software program?

the types of breaks already set up in Office Hours

On the New Break Entry dialog box, what information is displayed on the drop-down list in the Resource box?

patient information form

The __________ is used to collect information about the patient, including employment and insurance data needed to complete an insurance claim.

registration

The patient information form is also known as a ______ form.

assignment of benefits

A(n) ______________is an authorization by a policyholder that allows a health plan to pay benefits directly to a provider.

updated in

When established patients present for appointments, their patient and insurance information may need to be______ the practice management program if there have been changes.

Medicaid

__________ always pays last.

supplemental insurance

__________ covers parts of expenses, such as coinsurance, that patients must otherwise pay out-of-pocket under the primary plan.

birthday rule

The ________ is used to determine which of two parents' medical coverage is primary for their child.

has been in effect for the patient the longest

If a patient has coverage under two individual insurance plans, the primary plan is the one that

federal and state laws

Financial arrangements such as payment plans between patients and providers are governed by

payment

Financial policies should explain what is required of the patient and when _________ is/are due.

Patient tracking features

__________ are used during patient encounters to track where patients are during the different steps of the encounter.

patients' locations

Patient tracking features may be used during patient encounters to track ___________.

case

A __________ groups transactions for visits to a physician's office organized around a specific medical condition.

chart

The __________ number is a unique number that identifies a patient.

New Patient; Patient/Guarantor

In Medisoft Network Professional, information on a new patient is entered by clicking the ____________ button at the bottom of the Patient List dialog box to open the _________ dialog box.

Field

The entry in the __________ box controls how the list is sorted.

chart

The information required to complete the twelve tabs of the Case dialog box comes from documents found in a patient's

two

When the patient's two complaints are not related, how many cases should be used?

chief complaint and medical condition

Transactions are usually grouped into cases based on the ______________for which the patient seeks treatment.

chart

The __________ is a folder that contains all records pertaining to a patient.

Account

Assigned providers and case billing codes are entered on the ________ tab of the Case dialog box.

capitated

In a __________ plan prepayments are made to the physician from a managed care company to cover the physician's services to a plan member for a specified period of time, whether the member seeks medical care or not.

Medicaid and Tricare tab on the Case dialog box

Some patients have coverage under Medicaid or TRICARE. Where is additional information, beyond the basic data, entered in Medisoft Network Professional?

Condition

The __________ tab in Medisoft stores data about a patient's illness, accident, disability, and hospitalization.

Miscellaneous

The __________ tab records a variety of information about the patient and his or her treatment.

check-in

During which stage in the patient flow does a staff member confer with a patient to determine whether any information, such as a change in insurance or employment, needs to be updated in the patient record?

patient flow

The term ________________refers to the progression of patients from the time they enter the office for a visit until they exit the system by leaving the office after a physician visit.

education

When patients leave the exam room, they proceed to the checkout desk, where they receive additional information and patient _________ materials, and also make payments that are due.

past medical history

The_______________ includes any illness (past or present) for which the patient has received treatment.

General

The ____________ tab(s) of the Patient Lookup dialog box includes the most commonly used search options: patient name, patient ID, telephone number, and Social Security number.

blue rectangle

In Medisoft Clinical Patient Records, a folder that contains information has a _______ in the upper-right corner.

OK

When you are finished entering a note in Medisoft Clinical Patient Records, click the ____________ button to save the note.

typing

The information recorded in the history folders of the patient chart in Medisoft Clinical Patient Records can be completed by ___________ or with the aid of templates.

Refresh

If you have entered data in a history folder but it does not have a blue rectangle indicating that the data has posted, click the ______ button to update the screen.

allergies or intolerances to it noted in the folder

When a new medication is prescribed for a patient, MCPR checks whether the patient has any __________________.

reviewed

In addition to adding, editing, or deleting allergies and intolerances, Medisoft Clinical Patient Records also records the date that allergies were last _________ with the patient.

OK

Once the fields in the Allergy dialog box have been completed, clicking the _______ button saves the information and adds it to the list at the top of the Rx/Medications dialog box.

noted in

Medications that have been added, discontinued, or changed should be _________ the patient chart.

Prescription

Clicking the New button in the Current tab of the Rx/Medications dialog box activates the ________ dialog box.

25

To enter the size of a pill in the Rx/Medications folder, use up to ______ characters.

is open

In Medisoft Clinical Patient Records, progress notes can be created only when a patient chart

chief complaint

In most practices, the _____________ is entered as the title of the progress note for the patient's visit.

signature PIN

Medisoft Clinical Patient Records requires users to enter their__________to a progress note.

using the numeric keypad feature or typing them directly in the field

Numeric entries in the Vital Signs dialog box can be entered by

regular or irregular

On the Vital Signs dialog box, a drop-down menu next to the Pulse field is used to select whether the patient's pulse was_____________.

intra-office messages

Using Medisoft Clinical Patient Records, staff members can send

attachments and a link to the relevant portion of a patient's chart

A message can contain/include

yellow; Messages folders

When the Messages dialog box opens, the _____ column on the left lists all the _______.

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