Health management information

Question 1

Computer-based patient records (CPRs)

Answer 1

include any	
information taken at	doctor visits, hospital	visits, or any medical	
facility.
• Physicals
• Medical history
• Lab tests & imaging	reports
• Medication that has	been prescribed
• Referrals	
• Diagnoses & procedures
• Electronic Health	Record	(EHR)

Question 2

Personal Health Record (PHR)

Answer 2

computerized record about an individual patient’s health and health care, including medications, health insurance information, immunizations, allergies, medical test results, and family history.

Question 3

Transaction Processing Systems (TPS)

Answer 3

serve the people in the
operational level of an organization. A TPS collects and stores
information about transactions, and controls some aspects of
transactions

Question 4

Knowledge Work Systems (KWS)

Answer 4

are used by technical staff as model functions to convert design specifications into graphical designs. It uses computer-aided design/manufacture (CAD/CAM)

Question 5

Decision-Support Systems (DSS)

Answer 5

help upper-level management staff in decision-making. This type of system uses information, models, or analysis tools for managers to simulate and make predictions

Question 6

Office of Inspector General (OIG):

Answer 6

• Safeguards the health and welfare of the beneficiaries of Health and Human Services
(HHS) programs

• Protects the integrity of HHS programs
• Identifies and eliminates fraud, abuse, and waste
• Designed “to promote efficiency and economy in departmental operations”

Question 7

Protected Health Information (PHI)

Answer 7

The HIPAA privacy rule covers the use and disclosure of

patients’ protected health information (PHI).

Question 8

Right to Notice of Privacy Practices (NPP)

Answer 8

• Patients are entitled to receive the written Notice of Privacy Practices (NPP) of their provider at the first appointment; the front desk is the ideal place to distribute the NPP.

Question 9

ICD- 10 DM Coding databases should be…

Answer 9

reviewed and updated every year by October 1st

Question 10

Covered Entities

Answer 10

Are defined by HIPPA as:

• Health plans
• healthcare cleaning houses
• health care providers who electronically transmit any health info n connection with transactions for which HHS has adopted

Question 11

Covered Entities (Which location and offices are included)

Answer 11

• Physicians office
• Insurance companies
• Hospitals
• Doctors
• Clinics
• Psychologists
• Dentists
• Chiropractors
• Nursing Homes
• Pharmacies

Question 12

Battery

Answer 12

an intentional tort in which unconsented, harmful, or unwarranted physical conduct

Question 13

What is an Insurance and Coding Specialist expected to do?

Answer 13

• Find Missing Explanation of Benefits (EOB) info when permitting a front end office audit
• update new, revised, and deleted CPT codes in the practice management software on January 1st

Question 14

Federal Civil False Claim Act

Answer 14

a law that pertains to an insurance and coding specialist who knowingly present an incorrect CMS 1500 for payment to a payer

Question 15

Reason providers can terminate a patient relationship:

Answer 15

• If the patient is non-compliant w/ medical treatment
• the patient fails to make payment arrangements on a delinquent account
• patient consistently fails to keep appointments