health care delivery systems Flashcards
abstracting
data entry of codes and other pertinent information
accreditation
voluntary process that a health care facility or organizations undergoes to demonstrate that it has met standards beyond those required by law.
biometrics
an identifier that measures a borrowers unique physical characteristic or behavior and compares it to a stored digital template to authenticate the identity of the borrower, such as fingerprints.
(CMS)centers for Medicare and Medicaid services.
DHHS agency that administers medicare, medicaid CHIP.
code of federal regulations
codifications of the general and permanent rules published in the federal register by executive departments and agencies of the federal government
coding
assigning numeric and alphanumeric codes to diagnoses, procedures and services; this function is usually performed by credentialed individuals.
continuum of care
complete range of programs and services with the type of health care indicating the health care services provided
contract services
arranging with outside agencies to perform certain functions such as health information services
(cpt) curent procedural terminology
published annually by the American medical association; codes are 5 digits assigned to ambulatory procedures and services
deemed status
hospitals that are accredited by approved accreditation organizations are determined to have met or exceeded conditions of participation to participate in the medicare and medicaid programs.
deeming authority
when an accrediting organizations standards have met or exceeded CMS’s conditions of participation to participate in the medicare and medicaid programs.
digital signature
type of electronic signature that uses public key cryptography.
electronic health record
automated record system that contains a collection of information documented by a number of providers at the different facilities regarding one patient.
gina- genetic information nondiscrimination act
prohibits group health plans and health insurance companies from denying coverage to a healthy individual or charging higher premiums based solely on a genetic predisposition to development of disease in the future.
hcpcs lvl II(national) codes
developed by the centers for medicare and medicaid services and used to classify report procedures and services. codes are reported to 3rd party payers for reimbursement purposes
healthcare integrity and protection bank-HIPDB
created as a part of HIPAA to combat fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practioner’s, providers, or supplier’s past actions.
health care procedure coding system -HCPCS
comprimised of lvl 1 (cpt) and lvl 2 (national)codes
health plan employer data and information set -HEDIS
the national committee for quality assurance (NCQA) tool used for health plans to collect data about the quality of care and service they provide
Incomplete record processing
include the assembly and analysis of discharged patient records
ICD-1-0-CM INTERNATIONAL CLASSIFICATION OF DISEASES, TENTH RVISION CLINICAL MODIFICATION
used in the US to collect information about diseases and injuries and to classify diagnoses and procedures
Intranet
private network that utilizes internet protocols and technology and allows user to immediately and simultaneously access health care information with complete security and an audit trail, regardless of where users are located.
MIPS- merit based incentive payment system
payment system establishes as a part the medicare access and CHIP reauthorization act of 2015 that was signed into law on 4/16/15 that moves clinician medicare part b payment to a performance based payment system.
smart card
a card that contains a small central processing unit, some memory, and a small rectangular gold-colored contact area that interacts with card reader
SCHIP- state children’s health insurance program
health insurance program for infants, children, and teens that covers health care services such as doctor visits, prescribed meds, and hospitalizations. aka tittle XXI of the balanced budget act of 1997.
