Part 1 - Health Information Management, Concepts, Principles, and Practice Flashcards
biotechnology
the manipulation (as through genetic engineering) of living organisms or their components to produce useful, usually commercial, products (such as pest resistant crops, new bacterial strains, or novel pharmaceuticals)
health reimbursement account (HRA)
similar to HSAs but with a few significant differences; like HSAs, they are typically offered with a deductible-based health plan and encourage employees to control their healthcare costs as there is a fixed amount of resources available to the employee during the year. HRAs are completely funded by the employer, whereas the employee and the employer can fund HSAs. The employer funds and owns the account and money remaining at the end of the year may or may not be rolled over to the following year. Employee healthcare costs are paid out of the HRA tax-free.
health savings account (HSA)
also called medical savings accounts; HSAs provide a pretax way to save for future qualified medical and retiree health expenses. The benefit of an HSA is that the member pays for the deductible with pretax dollars, which allows a member to save the money that ordinarily would have gone to pay taxes. To open an HSA, a member must have a high-deductible insurance plan. The member pays for routine healthcare costs from their HSA. When members pay off the deductible, the insurance company begins to pay. The money in the HSA earns interest and is owned by the member who holds the account.
six elements of healthcare quality
a framework of quality created by the National Academy of Medicine (NAM); it outlines 6 things a healthcare facility needs to focus on: safety, effectiveness, patient-centeredness, speedy service, efficiency, and fair treatment towards all
organized healthcare delivery
systems in which healthcare providers have established relationships and mechanisms for communicating and working to coordinate patient care across health conditions, services, and care settings over time
post-acute care
care that includes rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital
multihospital system
two or more hospitals owned, leased, sponsored, or contract managed by a central organization
urgent care center
(sometimes called emergicenters or immediate care centers) places that provide diagnostic and therapeutic care for patients with minor illnesses and injuries. They do not serve seriously ill patients, and most do not accept ambulance cases. They are liked by patients due to convenience and approval by the insurance companies.
otorhinolaryngology
the study of diseases of the ear, nose, and throat
pulmonary medicine
the subspecialty of internal medicine that focuses on the diagnosis and management of disorders of the respiratory system
clinical privileges
permission to provide medical and other patient care services in the granting institution, within defined limits, based on the individual’s education, professional license, experience, competence, ability, health, and judgment (e.g. an internal medicine physician would be permitted to diagnose and treat a patient with pneumonia but not to perform a surgical procedure)
provisional
providing or serving for the time being only; existing only until permanently or properly replaced; temporary
modality
a particular mode in which something exists or is experienced or expressed
mode
a way or manner in which something occurs or is experienced, expressed, or done
bronchodilators
medications that relax muscle bands that tighten around your airways
gastroenterology
the branch of medicine focused on the digestive system and its disorders
sanatorium
(plural: sanatoria) an establishment for the medical treatment of people who are convalescing or have a chronic illness
convalescence
The gradual recovery of health and strength after illness or injury. It refers to the later stage of an infectious disease or illness when the patient recovers and returns to previous health, but may continue to be a source of infection to others even if feeling better. In this sense, “recovery” can be considered a synonymous term.
TRICARE
formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. Tricare is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities.
Veterans Health Administration (VHA)
a government agency that provides healthcare services to eligible veterans of military service
workers’ compensation
An insurance system operated by the individual states. Each state has its own law and program to provide covered workers with some protection against the costs of medical care and the loss of income resulting from work-related injuries and, in some cases, illnesses
arraign, arraignment
- to call (a defendant) before a court to answer to an indictment
- to accuse of wrong, inadequacy, or imperfection
indictment
- a formal charge or accusation of a serious crime
2. a thing that serves to illustrate that a system or situation is bad and deserves to be condemned
The “data, information, knowledge, and wisdom (DIKW) hierarchy” is a model used to show the relationship between data, information, knowledge, and wisdom.
Data represents raw facts. (e.g. traffic light is red)
Information represents the transformation of data into basic useful information. It provides answers to “who”, “what”, “where”, and “when” questions. (e.g. What does a red traffic light mean? Stop!)
Knowledge is the application of data and information; it answers “how” and “why” questions. (e.g. How and why did red come to mean stop with a traffic light? It will lead you to a bunch of information, ultimately showing that red is an effective color for making people stop and that the reason you make people stop is because it dramatically reduces the number of deaths due to car crashes).
Wisdom is an elevated understanding. It’s not just about how to reduce traffic accidents, but the wider meaning and application. It could mean applying concepts such as the traffic light to other situations (such as the use of red in business) or it can lead to a greater understanding that people need to be regulated to prevent great harm to society.
MEDCIN
an electronic medical record engine designed to allow for rapid entry, retrieval and correlation of relevant clinical information at the point of care, and to enable applications to store medical information as coded data elements and produce narrative reports from the same data
adverse determination
The term for when a healthcare insurer denies payment for proposed or already rendered healthcare service.
Collaborative Stage Data Set
A carefully selected, medically relevant set of data items that describe how far a cancer has spread at the time of diagnosis. Most of the data items have traditionally been collected by cancer registries, including tumor size, extension, lymph node status, and metastatic status.
metastasis
The spread of cancer cells from the place where they first formed to another part of the body.
staging system
A classification system that describes the extent of cancer within a patient.
respite care
Any inpatient care provided to a hospice patient for the purpose of giving primary caregivers a break from their caregiving responsibilities
rules of engagement
Rules that specify the way that policy makers, data owners, data stewards, and other stakeholders interact with each other.
esprit de corps
Morale, also known as esprit de corps, is the capacity of a group’s members to maintain belief in an institution or goal, particularly in the face of opposition or hardship.
bill hold period
The number of days in which accounts will be held from billing so charges can be entered after the patient is discharged (i.e. a grace period before customer’s bill is sent to be paid).
bill and hold
A bill and hold is a type of sales arrangement that enables payment ahead of the delivery of the item. It constitutes a sales arrangement in which a seller of a product bills a customer for the product upfront but does not ship the product until a later date.
MAP key
A set of 36 key performance indicators in revenue cycle for both hospitals and physician practices, developed by David Hammer.
MAP stands for:
- Measure performance
- Apply evidence-based strategies for improvement
- Perform to the highest standards across the board
It covers five broad areas:
- patient access
- revenue integrity
- claims adjudication
- accounting
- physician practice
accounting
The process of recording financial transactions pertaining to a business.
The accounting process includes summarizing, analyzing, and reporting these transactions to oversight agencies, regulators, tax collection entities, and management.
The financial statements used in accounting are a concise summary of financial transactions over an accounting period, summarizing a company’s operations, financial position, and cash flows.
Medically Unlikely Edits (MUEs)
Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the improper payment rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.
accounts receivable (A/R) days
The average number of days between the discharge date and the receipt of payment for services rendered as a measure of revenue cycle success.
advance beneficiary notice of noncoverage (ABN)
A written notice to inform patients when an outpatient item or service is not considered reasonable and necessary or may not be covered.
claims scrubber software
Software that contains a series of edits to determine if the claim is ready to be submitted.
Medicare Code Editor (MCE)
a software program used to detect and report errors in coding data while processing inpatient hospital Medicare claims
maximization
- a style of decision-making characterized by seeking the best option through an exhaustive search through alternatives
- (healthcare) an illegal attempt to maximize reimbursement to the highest possible amount through unethical coding practices such as upcoding
admit-discharge-transfer (ADT) message
A patient tracking mechanism that is transmitted from numerous systems within a healthcare facility as a patient moves through the system. It contains demographic information and other information, and can be sent by payer systems, registration systems, and EHRs.
web portal
A web portal is a specially designed website that brings information from diverse sources, like emails, online forums and search engines, together in a uniform way. Usually, each information source gets its dedicated area on the page for displaying information (a portlet); often, the user can configure which ones to display.
Variants of portals include mashups and intranet “dashboards” for executives and managers. The extent to which content is displayed in a “uniform way” may depend on the intended user and the intended purpose, as well as the diversity of the content.
mashup
A mashup (computer industry jargon), in web development, is a web page or web application that uses content from more than one source to create a single new service displayed in a single graphical interface. For example, a user could combine the addresses and photographs of their library branches with a Google map to create a map mashup.
matrix management
An organizational structure in which some individuals report to more than one supervisor or leader.
There are three types of matrix organizations as relates to project management:
Weak Matrix Organization: part-time project manager with limited authority
Balance Matrix Organization: project manager authority intermediate between weak and strong matrices
Strong Matrix Organization: full-time project manager with full authority
work breakdown structure (WBS)
a visual breakdown of work into small, manageable parts
a priori vs. a posteriori
A priori and a posteriori (‘from the earlier’ and ‘from the later’, respectively) are Latin phrases used in philosophy to distinguish types of knowledge, justification, or argument by their reliance on empirical evidence or experience.
A priori knowledge is that which is independent from experience. A good example is pure reason without evidence.
A posteriori knowledge is that which depends on empirical evidence. Examples include most fields of science.
veracity
- truth or accuracy
2. the quality of being truthful or honest
agile
- able to move quickly and easily
- relating to or denoting a method of project management, used especially for software development, that is characterized by the division of tasks into short phases of work and frequent reassessment and adaptation of plans
