Critical Concept Review Flashcards
A few Key concepts to know
Abuse
Abuse means actions that are improper, inappropriate, outside acceptable standards of professional conduct or medically unnecessary.
Examples of Abuse
- Pattern of waiving cost-shares or deductibles
- Failure to maintain adequate medical or financial records
- Pattern of billing claims for services not medically necessary
- Refusal to furnish or allow access to medical records
- Improper coding practices
Accessibility
The level of ease and efficiency at which data are legally obtainable, within a well protected and controlled environment
Accreditation
A voluntary program in which trained external peer reviewers evaluate a healthcare organization’s compliance and compare it with pre-established performance standards.
Accuracy
The extent to which the data are free of identifiable errors
Administrative Safeguards
Administrative actions, and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic protected health information and to manage the conduct of the covered entity’s workforce.
Aggregated Data
Data that has been extracted from individual health records and combined to form deidentified information about groups of patients that can be compared.
AHIMA Code of Ethics
Core Values beliefs
Alphabetic Filing System
Filed alphabetically by patients last name.
Alphanumeric Filing System
First two letters of patients last name followed by a unique numeric identifier. Ex. SA1234
Anti-kickback Statute
A criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs. Designed to program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services from healthcare professionals
American Recovery and Reinvestment Act. (ARRA)
Major health information technology law that provides stimulus funds to the US economy in the midst of a major economic downturn. Created HITECH
Audit Trail
A compliance manager’s reviewing tool that identifies when a user logs in and out
Authorization-
Covered Entity may not use or disclose protected health information without consent
Average length of Stay
Inpatient hospital stay that is 25 days or less
Benchmarking-
Compares organization standards against internal standards or external organizations.
Beneficence
Promoting good for others or providing services that benefit others. Such as releasing a record that will help someone.
Board of Directors
Elected group who are responsible for successful operation of the healthcare organization.
Cancer Registry
Records maintained by many states for the purpose of tracking the incidence new cases of cancer.
Case Finding
A method used to identify the patients who have been seen or treated in the facility for the particular disease or condition of interest to the registry.
Case Mix Index
The average relative weight of all cases treated a facility or by a given physician. This is calculated by dividing the sum of the weights of DRGS for patients discharged by the total number of patients discharged.
Case Mix
The distribution of a patient into categories reflecting difference in severity of illness or resource consumption.
Centralized Unit Filing
The patients encounters are filed in a single location.
Chargemaster
List of charges for the healthcare services and supplies at an organization.
Chief Privacy Officer
Responsible for privacy practices within the organization
Clinical Documentation Improvement-
The process an organization undertakes that will improve clinical specificity and documentation that will allow coders to assign more concise disease classification codes.
CMS
Centers for Medicare & Medicaid Services: Federal Agency within the US department of Health and Human Services. Oversight of Medicare & Medicaid programs and funding
Complete Worked Hours
Total work output - defective work = complete worked hours OR Completed Work / Hours worked to produce total work output
Compliance Officer
Checks the written standards of conduct
Comprehensiveness
The extent to which all required data within the entire scope are collected, documenting intended exclusions
Concurrent Review
Ongoing review while patient is in facility. From admission to discharge.
Conditions of Coverage-
Ensures patient quality
Conditions of Participation
Administrative and operational guidelines under which facilities are allowed to take part in the Medicare and Medicaid programs.
Confidentiality
Legal and ethical concept that requires healthcare providers to protect records and personal/private information. Responsibility to use
Consistency-
The extent to which the healthcare data are reliable, identical, and reproducible by different users across applications
Currency
The extent to which data are up-to-date; a datum value is up-to-date if it is current for a specific point in time, and it is outdated if it was current at a preceding time but incorrect at a later time
Custodian Records
When records for evidence is involved at the trial
Daily inpatient census
official count of inpatients present at midnight
Data Dictionary-
A listing of all the data elements within a specific system that defines each individual data element
Data Elements for Emergency Department Systems DEEDS
Emergency Room
Data Mapping
Allows for connections between two systems.
Data Mining-
Process of extracting information from a database then quantifying and filtering discrete
Data Normalization-
Critical process of bringing data into a common format that allows for collaborative research
Data Warehousing
Processes and systems used to archive data. Process of collecting data from sources within an organization for decision making purposes. Single database that helps locate data that exists in multiple databases.
Definition
The specific meaning of a healthcare-related data element
Delinquency Rate
Total number of delinquent records divided by/ number of discharges.
Disambiguated Data
A challenge in extracting meaningful data from unstructured text. Clinical notes often contain terms that have more than one meaning. Example: Cold- a disease or body temperature/ Discharge- body fluid or leaving hospital.
Duplicate Record
2 or more medical record numbers.
Electronic Document Management SystemEDMS-
Used to track manage and store documents.
EMTALA-
Emergency Medical Treatment and Active Labor Act- Determines if an emergency condition exists.
Enterprise MPI-
Links the patient’s information at the different facilities when they go to multiple places.
Essential Medical Data Set EMDS
Emergency Care Setting
Expressed Consent-
Consent given by their words or in writing.
False Claims Act
Penalties to those who knowingly submit fraudulent claims to Government for payment.
fish bone chart
a performance improvement tool used to identify or classify the root causes of a problem or condition and to display the root causes graphically; also called the cause and effect diagram
flowchart
a graphic tool that uses standard symbols to visually display detailed information
Fraud-
Intentionally executes or attempts to execute a scheme to obtain money or any healthcare benefit program.
Granularity-
Data collected must be at appropriate level of detail
