21 terms

Chapter 2 - Information Technology & HIPAA

information technology (IT)
development, management, and support of computer-based hardware/software systems
electronic medical record (EMR)
electronic collection and management of health data
electronic prescribing
the use of computers and handheld devices to write and transmit prescriptions to a pharmacy in a secure digital format
a service company that recieves electronic or paper claims from the provider, checks and prepares them for processing, and transmits them in HIPAA-complaint format to the correct carriers
audit/edit report
a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer
walkout statement
a document listing charges and payments that is given to a patient after an office visit
an automated process for entering information on a remittance advice (RA) into a computer
HIPAA - Health Insurance Portability and Accountability Act of 1996
federal act that set forth the guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs and protecting the security and privacy of health information
HIPAA- Electronic Transaction and Code Sets standards
regulations requiring electronic transactions such as claim transmission to use standardized formats
electronic data interchange (EDI)
the exchange of routine business transactions from one computer to another using publicly available communications protocols
electronic funds transfers (EFT)
a system that transfers money electronically
X12-837 Health Care Claim (837P)
HIPAA standard format for electronic transmission of a professional claim from a provider to a health plan.
CMA-1500 (08/05)
the mandated paper claim form that can be used in some practices of less than 10 fulltime employees
national provider identifier (NPI)
a standard identifier for all health care providers consisting of ten numbers.
HIPAA Privacy Rule
regulations for protecting individually identifiable information about a patient's past, present, or future physical and mental health and payment for health care that is created or received by a health care provider
protected health information (PHI)
information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person
HIPAA Security Rule
regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information
administrative safeguards
administrative policies and procedures designed to protect electronic health information outlined by the HIPAA security rule.
physical safeguards
mechanisms required to protect electronic systems, equipment and data from threats, environmental hazards and unauthorized intrusion
technical safeguards
automated processes used to protect data and control access to data
audit trail
a report that traces who has accessed electronic information, when information was accessed, and whether any information was changed