Practice Management & EMR Flashcards
Credentials
Login information to access software, such as username and password
Practice management
Software used for administrative and billing tasks, such as scheduling appointments, generating reports, and billing insurance providers and patients
Electronic health records
A platform that can be accessed, managed, and consulted across more than one health care organization; refers to the shared information from all clinicians involved in a patient’s care
Electronic medical records
Used to record patient health information in a digital format that allows the provider to track a patient’s health over time, improving the quality of care
Patient education
Application within an electronic health record that provides access to a comprehensive list of patient education material that is provided to educate or instruct a patient based on the patient’s condition and treatment options
HIPAA
Health insurance portability and accountability act of 1996; United States legislation that assures patient privacy and security provisions for medical information
Meaningful use
A set of specified objectives that medical providers must meet in order to prove that they are using their ehr as an effective tool in their practice
1) using certified EHR technology to improve quality, safety, efficiency, and reduce disparities
2) Engaging patients and family
3) improving care coordination, and population and public health
4) maintaining privacy and security of patient health information
Reference sheet
Shows all patients scheduled for an office visit for a specified time period
Secondary insurance
When a patient has more than one insurance coverage, the secondary is the one that pays after the primary has paid its portion, according to the benefits available under the secondary plan
Patient portal
A secure online website that provides patients with 24 hour access to their medical information; details on the office visits, procedures, or medications; communication with staff and providers; methods to request or schedule appointments online; or other types of patient interaction with the clinic through an internet connection
Encounter form
Also known as superbill , a charge ticket, or visit/ fee slip; contains all of the information insurance companies require in order to consider a claim for payment
Remittance advice
Aka explanation of benefits. A document that provides details on claims billed to the insurance, and how the claims were paid, including information on allowables, deductibles, adjustments, and net payment. May be accompanied by a payment in the form of a check or may refer to an electronic funds transfer.
Medical care
Identification of disease and the provision of care and treatment to persons who are sick, injured, or concerned about their health status
Health care
Expands the definition of medical care to include preventive services, which are designed to help individuals avoid health and injury problems
Health care insurance
A contract between a policyholder and a third party payer or government health program to reimburse the policyholder for all or a portion of the cost of medically necessary preventive care provided by health care professionals
Policyholder
A person who signs a contract with a health insurance company and owns the insurance policy
Third party payer
A health insurance company that provides coverage
Payer mix
Different types of health insurance payments that are reimbursement
Group health insurance
Health insurance coverage subsidized by employers and other organizations
Individual health insurance
Private health insurance policy purchased by individuals or families who do not have access to group health insurance
Public health insurance
Federal and state health programs (Medicaid, Medicare, chip, Tricare)
Single payer system
Centralized health care system adopted by some western nations (Canada) and funded by taxes
Socialized medicine
A single payer system in which the government owns and operates healthcare facilities and providers (Finland, Great Britain)
Universal health insurance
The goal of providing every individual with access to health coverage, regardless of the system implemented to achieve that goal (Obamacare)
Federal employer’s liability act
Legislation that protects and compensates railroad workers who are injured on the job
Federal employees compensation act
Provides civilian employees of the federal government with medical care, survivors benefits, and compensation for lost wages
Hill-Burton Act
Provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and World War Two. In return for federal funds, facilities were required to provide services free or at reduced rates to patients unable to pay for care
Third party administrators
Administer health care plans and process claims, thus serving as a system of checks and balances for labor and management
World Health Organization
Developed the ICD (International classification of diseases), a classification system used to collect data for statistical purposes
Major medical insurance
Provided coverage for catastrophic or prolonged illnesses and injuries
Deductible
The amount for which the patient is financially responsible before an insurance policy provides payment
Lifetime maximum
The maximum benefits payable to a health plan participant
Medicare
Provides health care services to Americans over the age of 65
Medicaid
A cost sharing program between the federal and state governments to provide health care services to low income Americans
Civilian health and medical program - uniformed services
Designed as a benefit for dependents of personnel serving in the armed forces (Tricare)
Cpt
Current procedural terminology
Developed by the American medical association. Includes changes that correspond to significant updates in medical technology and practice
Self insured employer-sponsored group health plans
Large employers are allowed to assume the financial risk for providing health care benefits to employees
OSHA
Occupational Safety and Health Administration
Designed to protect all employees against injuries from occupational hazards in the workplace
Civilian health and medical program of department of veterans affairs
Champva
Provide health care benefits for dependents of veterans rated as 100 percent permanently and totally disabled as a result of service connected conditions, veterans who died as a result of service connected conditions, and veterans who died on duty with less than 30 days of active service
Employee retirement income security act of 1974
Mandated reporting and disclosure requirements for group life and health plans, permitted large employers to self insure employee health care benefits, and exempted large employers from taxes on health care premiums
Copay
A provision in an insurance policy that requires the policyholder to pay a specified dollar amount to a health care provider for each visit or medical service received
Coinsurance
The percentage of costs a patient shares with the health plan
CMS
Centers for Medicaid and Medicare services
Medicare advantage plan
A type of medical plan that replaces original Medicare and provides all part a and part b benefits. Silver sneakers, prescription drugs, fit program, hmos, ppos, fee for service plans, Medicare medical savings account plans, and special needs plans are all available.
Dependent
Eligibility refers to who can be added onto an insurance plan where the policyholder is someone else. Typically spouses and children
New patient
An individual who has not received services from the provider, or from an associate provider of the same specialty who belongs to the same group practice, within the past three years
