Essentials of HIM: Ch1 - Health Care Delivery Systems
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182 terms
Terms | Definitions |
|---|---|
 Imhotep | World's first known physician |
| Hippocrates | Father of medicine |
| Hippocratic Oath | Adopted as an expression of early medical ethics |
| Leeuwenhoek | First to use a microscope to examine microbes |
| Pasteur and Koch | Established the theory of disease |
| Pasteur | Proved that microbes are living organisms and that killing microbes stops the spread of disease |
| Lister | Starting using disinfectant to sterilize surgical wounds and invented aseptic surgery |
| Roentgen | Discovered x-rays |
| Curie | Discovered radium and provided a weapon for cancer |
| Ehrlich | Introduced chemotherapy |
| Fleming | Discovered Penicillium |
| Florey | Isolated penicillin from the mold. |
| 1981 | Year HIV and AIDS were identified |
| Pennsylvania Hospital | Benjamin Franklin founded this first United States hospital in 1751 |
| 1847 | The American Medical Association was founded in this year. |
| American Medical Association | AMA stands for __________. |
| American Osteopathic Association | AOA stands for _________. |
| American College of Surgeons | ACS stands for _________. |
| American College of Surgeons | This organization was founded in 1913 to improve the quality of care for surgical patients by establishing standards for surgical education and practice. |
| 1946 | The Centers for Disease Control was established in this year |
| Centers for Disease Control | CDC stands for __________. |
| Joint Commission on Accreditation of Hospitals | This independent, non-profit organization was created in 1951 to provide voluntary accreditation |
| 18 | Medicare is title _____ of the Social Security Amendments of 1965. |
| 19 | Medicaid is title ____ of the Social Security Amendments of 1965. |
| Health Care Financing Administration | The Centers for Medicare & Medicaid Services used to be called the ___________. |
| Health Care Financing Administration | HCFA stands for _______. |
| Centers for Medicare & Medicaid Services | CMS stands for _______. |
| Tax Equity and Fiscal Responsibility Act of 1982 | This act established the first Medicare prospective payment system which was implemented in 1983. It allowed the implementation of Diagnosis Related Groups. |
| Tax Equity and Fiscal Responsibility Act | TEFRA stands for _______. |
| COBRA | Established in 1985, this allowed former employees, retirees, spouses, domestic partners, and eligible dependent children who lose coverage the right to temporary continuation of health coverage at group rates. |
| Consolidated Omnibus Budget Reconciliation Act | COBRA stands for ________. |
| Emergency Medical Treatment and Labor Act | Established in 1985, this act addressed the problem of hospitals' failure to screen, treat, or appropriately transfer patients by establishing criteria for the discharge and transfer of Medicare & Medicaid patients. |
| Emergency Medical Treatment and Labor Act | Also known as the antidumping statute |
| Emergency Medical Treatment and Labor Act | EMTALA stands for ________. |
| Patient Self-Determination Act | Established in 1990, this act required consumers to be provided with informed consent, information about their right to make advanced health care decisions (advanced directives), and information about state laws that impact their legal choices in health care decisions. |
| advanced directives | Do Not Resusciate Order, Durable Power of Attorney for Health Care, Health Care Proxy, Living Will, and Organ/Tissue Donation are examples of _________. |
| Health Insurance Portability and Accountability Act | Established in 1996, this act mandates administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information. |
| Health Insurance Portability and Accountability Act | HIPAA stands for __________. |
| 2001 | Health Care Financing Administration changed their name to the Centers for Medicare & Medicaid services in what year? |
| Medicare Prescription Drug Improvement and Modernization Act | Established in 2003, this act restructured medicare in order to provide recipients with prescription drug savings and additional health care plan choices. |
| Medicare Prescription Drug Improvement and Modernization Act | MMA stands for _________. |
| American Recovery and Reinvestment Act | In 2009, this act authorized an expenditure of $1.5 billion for grants for the acquisition of health information technology systems. |
| continuum of care | A complete range of programs and services |
| primary care | Services that include preventive and acute care; the point of first contact. |
| primary care | Services typically provided by a general practitioner or other health professional who has first contact with a patient seeking treatment. |
| secondary care | Services provided by a medical specialist or hospital staff members to a patient whose primary care was provided first by a general practitioner. |
| tertiary care | Services provided by a specialized hospital equipped with diagnostic and treatment facilities not generally available at hospitals. |
| tertiary care | Hospitals that provide burn center treatment, neonatology, neurosurgery, and pediatric surgery provide ___________. |
| quaternary care | Advanced services provided by tertiary care centers that are highly specialized and not widely used. |
| for-profit | Privately owned hospitals; excess income is distributed to shareholders and owners. |
| not-for-profit | Hospitals that reinvested extra income back into the facility. |
| government, voluntary | Two types of not-for-profit hospitals are _________. |
| government supported | Hospitals that are supported by local, regional, or federal taxes. |
| 25 | Government supported hospitals make up _______ percent of all health care facilities. |
| government supported | A VA hospital is an example of a __________ facility. |
| proprietary | Hospitals owned by corporations or private foundations. |
| 15 | Proprietary hospitals make up _____ percent of all health care facilities. |
| voluntary | Not-for-profit hospitals operated by religious or other not-for-profit groups. |
| 60 | Voluntary hospitals make up _____ percent of all health care facilities. |
| teaching | Hospitals affiliated with a medical school. |
| Intern | An individual in their first year of graduate medical education. |
| resident | A physician who has completed an internship and is engaged in a program of training designed to increase his or her knowledge of the clinical discipline. |
| chief resident | Physician in his or her final year of residency. |
| Domagk | Discovered the ability of sulfa drugs to cure infections |
| 1955 | Year the Salk polio vaccine was licensed |
| 1765 | Year the first medical school was founded |
| University of Pennsylvania | The first medical school was founded at ____________. |
| 1913 | Year American College of Surgeons was founded. |
| 1897 | Year American Osteopathic Association was founded. |
| 1935 | Year Congress passed the Social Security Act. |
| 1965 | Year Medicare and Medicaid was established |
| 1951 | Year the Joint Commission was established. |
| governing board; administration; medical staff; departments, services, and committees; contracted services | What is the top-down organizational structure for a health care facility? |
| governing board | Group that serves without pay and is represented by professionals from the business community. |
| governing board | This group is responsible for hospital organization, management, control and operations, and for appointing medical staff. |
| governing board | This group is responsible for the overall health of the organization. |
| hospital administration | Group that serves as a liaison between the medical staff and the governing board. |
| hospital administration | This group is responsible for developing a strategic plan for supporting the mission and goals of the organization. |
| CFO | This person reports to CEO and is responsible accounting, billing, and payroll |
| CIO | This person reports to the CEO and is responsible for information resource management. |
| COO | This person reports to CEO and is responsible for ancillary services. |
| medical staff | Consists of licensed physicians and other licensed providers as permitted by law who are granted clinical privileges. |
| governing board | The medical staff is approved by the ___________. |
| clinical departments, medical specialty, chairperson, medical staff committees, hospital committees | The medical staff is organized into ________ by _________, with a _________ appointed to each department, and members to serve on ____________ and ___________. |
| medical staff credentials committee | This group reviews and verifies medical staff applications and submits recommendations to the executive committee. |
| department chairperson | Once the credentials committee reviews a medical staff application, the application then goes to this person. |
| executive committee | This group reviews medical staff applications and recommendations, votes, and makes recommendations to Medical Staff. |
| active | Medical staff involved in the delivery of medical services and administrative functions. |
| associate | Medical staff under consideration for active status |
| consulting | Highly qualified medical staff that provide expertise in an specific area |
| courtesy | Medical staff who occasionally admits a patient to the hospital |
| honorary | Former medical staff held in high regard and honored with emerti status |
| bylaws | The rules and regulations of the health care organization as guided by federal and state regulations and accreditation standards. |
| bylaws | These are created and voted on by the medical staff; they delineate medical staff responsibilities. |
| departments | Clinical laboratory, HIM, radiology, medical staff are examples of hospital ____________. |
| committees | Hospital ______________ are multidisciplinary and comprised of representatives from various departments. |
| agenda | A listing of all items of business to be discussed |
| review minutes, old business, member reports, new business, other business, next meeting, adjournments | List the seven items on a standard agenda. |
| minutes | Concise, accurate records of actions taken and decisions made during the meeting. |
| date, place, time of meeting; members present; members absent; guests present; items discussed; actions taken; adjournment time; date, place, time of next meeting; secretary's name and signature | What 9 things should be in the meeting minutes? |
| health information | Department responsible for allowing appropriate access to patient information in support of clinical practice, health services, and medical research while maintaining confidentiality of patient and provider data. |
| RHIA, RHIT | Health information administrative functions are directed by __________ and _________. |
| HIM administrators | These individuals develop, monitor, and improve HIM systems, ensure continuous quality operation, participate in committees, and establish department policies and procedures. |
| cancer registrars | These individuals use computerized registry software to conduct lifetime follow-up on cancer patients, electronically transmit data to state and national agencies, and generate reports and information for requesting entities. |
| cancer registrars | These individuals coordinate the national survey process through the ACS commission on cancer and arrange monthly or bi-monthly cancer committee meetings. |
| coding | Involves assigning numeric and alphanumeric codes to diagnoses, procedures, and services. |
| RHIA, RHIT, CCS | Coding is performed by _______, __________, or _______. |
| CPT | Coding method used only for ambulatory/outpatient procedures and services. |
| current procedural terminology | CPT stands for _________. |
| AMA | CPT is put out by the _________. |
| ICD-9-CM | Used to collect information about diseases and injuries and to classify diagnosis and procedures. |
| HCPCS Level II | Codes developed by CMS and used to classify report procedures and services. |
| health care procedure coding system | HCPCS stands for __________ |
| image processing | HIM department responsible for converting paper to electronic health records via digital media, scanned images, and voice recognition. |
| need-to-know | Only employees who have been granted ________ status are allowed access to EHR. |
| locked | Records that are in litigation or behavioral health records are usually _________. |
| incomplete record processing | This included the assembly and analysis of discharged patient records for deficiencies. |
| universal chart order | All records are organized in the same order as when the patient was on the nursing floor. |
| logged into the tracking system, physician is notified | Once the record is analyzed for deficiencies, it is __________, and then __________. |
| medical transcription | Involves the accurate and timely transcription of dictated reports |
| record circulation | Includes the retrieval of patient records for the purpose of inpatient readmission, outpatient clinic visits, authorized quality management studies, and education and research. |
| cancer registry, coding, document conversion, medical transcription, release of information, trauma registry | Provide six examples of HIM contracted services. |
| licensure | State laws require a health care facility to obtain this before providing services to patients. |
| regulation | An interpretation of a law that is written by the responsible regulatory agency. |
| Code of Federal Regulations | The codification of the general and permanent rules published in the Federal Register. |
| accreditation | The voluntary process that a health care facility or organization undergoes to demonstrate it has met standards beyond those required by law. |
| standards | Measurements of a health care organization's level of performance in specific areas - more rigorous than regulations |
| survey | Process conducted both off-site and on-site to determine whether the facility complies with standards. |
| deemed status | Organization has met the conditions of participation which allows them to accept reimbursement for CMS |
| ORYX initiative | Integrates outcomes and other performance measurement data into the accreditation process for quality improvement purposes. |
| Shared Visions - New Pathways Initiative | Changed the scoring and accreditation process, focusing on whether organizations are making improvements system-wide. |
| Periodic performance review | Developed by the joint commission, this is a continuous survey process that helps organizations meet the continuous demand for accountability and is used for self-evaluation. |
| National Patient Safety Goals | Developed by the JC, these help organizations focus on providing high quality patient care. |
| privacy, security, electronic transactions standards | HIPAA sets regulations for the _______, _______, and __________ for health care information. |
| predetermined rate, discharge diagnosis | Diagnosis related groups required acute care hospitals to be reimbursed at a ______ according to ________. |
| hippocrates | First to consider medicine both a science and art, separate from practice of religion. |
| ACS | The _______ developed the minimum standard for hospitals. |
| voluntary accreditation | The primary purpose of the Joint Commission is to provide ________. |
| professionals from the community | The membership of the governing board is represented by _________. |
| credentials | This committee consists of medical staff who review and verfy medical staff applications. |
| utilization management | A person from this department works with case managers of insurance companies to determine the appropriateness of admissions. |
| incomplete record processing | The assemby and analysis of discharged patient records. |
| procedures and services | The CPT coding book is published annually to assign what type of codes. |
| AMA | Who publishes the CPT coding book? |
| risk management | A hospital committee that is responsible for analyzing trends of accidents and establishing priorities for dealing with high-risk areas is ___. |
| National Committee for Quality Assurance | Private non-profit organization established to assess and report on the quality of managed care plands is called the _______. |
| better, higher quality | Health care consumers are _____ educated and demand _______ health care. |
| modern | The implementation of standards for sanitation, ventilation, hygiene, and nutrition occurred during ______ medicine. |
| monks and nuns | In the Middle Ages, the care of patients was based on charity and was often managed by _______. |
| written authorization, court order | Health care information can be released only with patient's _____ or by a ______. |
| electronic health record | Automated, accessible record containing multimedia data. |
| electronic signature | Encompasses all technology options available used to authenticate a document. |
| disaster control | Committee responsible for establishing a disaster plan. |
| health information | Committee responsible for ongoing review of patient records for timely completion and quality of documentation. |
| quality management | Committee concerned with the quality of care provided to patient. |
| risk management | Committee responsible for coordinating and monitoring activities, analyzing trends of incidents, and establishing priorities for dealing with potentially dangerous areas. |
| utilization management | Committee concerned with appropriate use of resources for providing patient care. |
| ethics | Committee that meets as needed in order to discuss ethical problems. |
| executive | Committee that acts on reports and recommendations from medical staff committees. |
| joint conference | Committee that serves as a liaison betwee governing body and administration. |
| abstracting | The purpose of ______ is to generate statistical reports, and disease/procedure indexes which are used for administrative decision-making and quality-management purposes. |
| standard, medical education | The original purpose of the AMA was to elevate the ______ of _______. |
| art, science, betterment, public health | The current purpose of the AMA is to promote the _____ and _____ of medicine and the ______ of ______. |
| American hospital association | AHA |
| american hospital association | National organization that represents and serves all types of hospitals, health care networks, and their patients and communities |
| peer review organizations | What group replaced PSROs in 1982? |
| peer review organizations | Implemented in 1982, these organizations monitored utilization and quality control. |
| quality improvement organizations | In 2002, PROs were replaced with _____? |
| quality improvement organziations | These organizations, established in 2002, perform quality control and utilization review of health care furnished to Medicare beneficiaries. |
| professional standards review organziations | Established in 1972 by the Social Security Amendments, these peer review organizations monitor appropriateness, quality, and outcome of services provided to beneificiaries of Medicare, Medicaid, and Maternal and Child Health Programs. |
| Social security | When it was originally established, what act included unemployment insurance, old-age assistance, aid to dependent children, and grants to states to provide various forms of medical care? |
| unemployment insurance, old age assistance, dependent children, medical care | When it was originally established, social security included: _______, _______, aid to ______, and grants to states to provide ______. |
| CEO | This person oversees, the CFO, CIO, and COO. |
| house officers | Physicians whose only job is to work at the facility treating patients. |
| governing board | This group grants medical staff clinical privileges. |
| The Joint Commission | What organization was established in 1951 to develop professionally based standards to evaluate compliance of health care organizations? |
| medicare | Comprehensive health care available to people 65 years of age or older, certain younger people with disabilities, and people with end-stage renal disease. |
| medicaid | A joint federal and state program that helps with medical costs for people with low incomes and limited resources. |
| reverse chronological order | Inpatient reports are filed in _______ within each section of the record. |
| chronological order | Discharged patient reports are filed in _____ within each section of the record. |
| hippocrates | Which physician was the first to consider medicine a science? |
| component state organizations | The AHIMA House of Delegates are composed of delegates from _____. |
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