Random Flashcards
Utilization Review Act of 1977
Utilization Review act requires hospitals to conduct a continued-stay review on all Medicare and Medicaid patients admitted in the hospital to determine if their continued stay is medically necessary.
Deterministic Algorithms
Deterministic Algorithms is used in searching the Master Patient Index (MPI) for exact match of data elements like date of birth or social security number to find overlays or overlaps of patient’s information.
Overlay
2 separate patients who have their medical information mixed together in one chart
Overlap
One patient with multiple health records at different locations in the same health system.
Ex: maiden name registered at outpatient clinic, married name registered inpatient admission.
Duplicate
One patient has multiple record numbers in one facility.
Example registered with a middle initial or registered with error inputting date of birth.
HEDIS
Healthcare Effectiveness Data and Information Set. (HEDIS) from the NCQA it collects administrative data, claims data, and health record review data related to patient outcomes and effectiveness. Basically tracking quality of care.
LIS
Laboratory Information System
Part of acute care setting this system will receive and order for lab work, generate a specimen work list, print specimen labels, create an accession number to track specimen and receive results.
RIS
Radiology Information System (RIS) part of the hospital system it receives the order for a procedure, scheduled it, notifies personnel to perform procedure, tracks results
OASIS
Outcomes and assessments Information set. It is the data set for skilled home health care of Medicare and Medicaid patients.
Think “my home is my oasis”
UHDDS
Uniform Hospital Discharge Data Set (UHDDS)
A data set required by HHS for acute care setting (inpatient hospital) they used CMS 1450 claim form or UB04 & 837i electronic claim form to collect this data
PAI
Patient Assessment Instrument it is Assessment tool completed at admission and discharge of a REHABILITATION facility.
RAI
Resident Assessment Instrument (RAI) required by the federal govt a critical component to the LONG-Term care record. It is the care plan format based on MDS, triggger conditions, utilization guidelines, care area Assessments. Residents are assessed and reassessed every 60 days or earlier depending on condition. RAI is submitted to the state health dept then into CMS. Surveyors use this information
CLIA
Clinical Laboratory Improvement Amendments (CLIA)
Regulates the QUALITY of lab testing and would prohibit access. A Covered Entity (CE) can deny a patient access to PHI without opportunity to review or appeal.
> 50 years and PHI
over 50 years a deceased patients records are no longer protected by HIPAA.
Omnibus Rule
2013 modification to ARRA and HITECH strengthen privacy and security makes CE and BA liable for compliance, limits PHI disclosure for marketing, research, fundraising.
