Terms Flashcards
Abbreviated Injury Scale
An anatomically-based, consensus-derived global severity scoring system that classifies each injury by region according to its relative importance on a 6-point ordinal scale (1 = minor and 6 = maximal). AIS is the basis for the Injury Severity Score (ISS) calculation of the multiply injured patient (AAAM 2008)
ABC Codes
Codes that consist of five-character, alphabetic strings that identify services, remedies, or supplies. Codes are followed by a two-character code modifier, which identifies the practitioner type who delivered the care (Alternative Link 2009)
Aberrancy
Services in medicine that deviate from what is typical in comparison to the national norm
Abortion
The expulsion or extraction of all (complete) or any part (incomplete) of the placenta or membranes, without an identifiable fetus or with a live-born infant or a stillborn infant weighing less than 500 grams
Absolute frequency
The number of times that a score of value occurs in a data set
Abstracting
- The process of extracting information from a document to create a brief summary of a patient’s illness, treatment, and outcome 2. The process of extracting elements of data from a source document or database and entering them into an automated system
Accept assignment
A term used to refer to a provider’s or a supplier’s acceptance of the allowed charges (from a fee schedule) as payment in full for services or materials provided
Accession number
A number assigned to each case as it is entered in a cancer registry
Accession registry
A list of cases in a cancer registry in the order in which they were entered
Accountable Care Organization (ACO) Participant
An individual or group of ACO provider(s)/supplier(s) that is identified by a Medicare-enrolled TIN, that alone or together with one or more other ACO participants comprise(s) an ACO, and that is included on the list of ACO participants that is required under 425.204(c)(5) (42 CFR 425.20 2011)
Accounting of disclosures
- Under HIPAA, a standard that states (1) An individual has a right to receive an accounting of disclosures of protected health information made by a covered entity in the six years prior to the date on which the accounting is requested, except for disclosures. To carry out treatment, payment, and health care operations as provided in 164.506
Accounting rate of return
The projected annual cash inflows, minus any applicable depreciation, divided by the initial investment
Accounts payable (A/P)
Records of the payments owed by an organization to other entities
Accounts receivable (A/R)
- Records of the payments owed to the organization by outside entities such as third-party payers and patients 2. Department in a healthcare facility that manages the accounts owed to the facility by customers who have received services but whose payment is made at a later date
AAAH
Accreditation Association for Ambulatory Health Care
ACHC
An organization that provides quality standards and accreditation programs for home health and other healthcare organizations (ACHC 2013)
Accredited Standards Committee X12 (ASC X12)
A committee accredited by ANSI responsible for the development and maintenance of EDI standards for many industries. The ASC “X12N” is the subcommittee of ASC X12 responsible for the EDI health insurance administrative transactions such as 837 Institutional Health Care Claim and 835 Professional Health Care Claim forms (Accredited Standards Committee 2013)
Accrue
The process of recording known transactions in the appropriate time period before cash payments/receipts are expected or due
Acid-test ratio
A ratio in which the sum of cash plus short-term investments plus net current receivables is divided by total current liabilities
ACOG
American Congress of Obstetrics and Gynecology
Action plan
A set of initiatives that are to be undertaken to achieve a performance improvement goal
Active record
A health record of an individual who is a currently hospitalized inpatient or an outpatient
Activity-based costing (ABC)
An economic model that traces the costs or resources necessary for a product or customer
Activity date or status
The element in the chargemaster that indicates the most recent activity of anitem
Actual charge
- A physician’s actual fee for service at the time an insurance claim is submitted to an insurance company, a government payer, or a health maintenance organization; may differ from the allowable charge 2. Amount provider actually bills a patient, which may differ from the allowable charge
Acute-care hospital
Under HITECH specific to the Medicaid program, a health care facility (1)where the average length of patient stay is 25 days or fewer; and (2) with a CMS certification number (previously known as the Medicare provider number) that has the last four digits in the series 0001–0879 or 1300–1399 (42 CFR 495.302 2012)
Acute-care prospective payment system
The Medicare reimbursement methodology system referred to as the inpatient prospective payment system (IPPS). Hospital providers subject to the IPPS utilize the Medicare severity diagnosis-related groups (MS-DRGs) classification system, which determines payment rates (CMS 2012)
ADA
Americans with Disabilities Act
Addendum
A late entry added to a health record to provide additional information in conjunction with a previous entry. The late entry should be timely and bear the current date and reason for the additional information being added to the health record
Add-on codes
In CPT coding, add-on codes are referred to as additional or supplemental procedures. Add-on codes are indicated with a “+” symbol and are to be reported in addition to the primary procedure code. Add-on codes are not to be reported as standalone codes and are exempt from use of the –51 modifier (AMA 2013)
Addressable standards
As amended by HITECH, the implementation specifications of the HIPAA Security Rule that are designated “addressable” rather than “required”; to be in compliance with the rule, the covered entity must implement the specification as written, implement an alternative, or document that the risk for which the addressable implementation specification was provided either does not exist in the organization, or exists with a negligible probability of occurrence (45 CFR 164.306 2013)
Adjusted clinical groups (ACGs)
A classification system developed by John Hopkins University that groups individuals according to resource requirements and reflects the clinical severity differences among the specific groups; formerly called ambulatory care groups (IASIST 2013)
Adjusted historic payment base (AHPB)
The weighted average prevailing charge for a physician service applied in a locality for 1991 and adjusted to reflect payments for services with charges below the prevailing charge levels and other payment limits; determined without regard to physician specialty and reviewed and updated yearly since 1992
Adjusted hospital autopsy rate
The proportion of hospital autopsies performed following the deaths of patients whose bodies are available for autopsy
Administrative data
Coded information contained in secondary records, such as billing records, describing patient identification, diagnoses, procedures, and insurance
Administrative information
Information used for administrative and healthcare operations purposes, such as billing and quality oversight
Administrative safeguards
Under HIPAA, are administrative actions and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic protected health information and to manage the conduct of the covered entity’s or business associate’s workforce in relation to the protection of that information (45CFR 164.304 2013)
Administrative services only (ASO) contract
An agreement between an employer and an insurance organization to administer the employer’s self-insured health plan
Administrative simplification
As amended by HITECH, authorizes HHS to: (1) adopt standards for transactions and code sets that are used to exchange health data; (2) adopt standard identifiers for health plans, health care providers, employers, and individuals for use on standard transactions; and (3) adopt standards to protect the security and privacy of personally identifiable health information (45 CFR Parts 160, 162, and 164 2013)
Admission-discharge-transfer (ADT)
The name given to software systems used in healthcare facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system
Admission utilization review
A review of planned services (intensity of service) or a patient’s condition (severity of illness) to determine whether care must be delivered in an acute care setting
Advance beneficiary notice (ABN)
A notice that a doctor or supplier should give a Medicare beneficiary when furnishing an item or service for which Medicare is expected to deny payment. If you do not get an ABN before you get the service from your doctor or supplier, and Medicare does not pay for it, then you probably do not have to pay for it (CMS 2013)
Adverse action
A term used when an organization chooses to take action against an individual practitioner’s clinical privileges or membership; Also called licensure disciplinary action
Adverse selection
A situation in which individuals who are sicker than the general population are attracted to a health insurance plan, with adverse effects on the plan’s costs
Affinity diagram
A graphic tool used to organize and prioritize ideas after a brainstorming session
Affinity grouping
A technique for organizing similar ideas together in natural groupings
Agency for Healthcare Research and Quality (AHRQ)
The branch of the US Public Health Service that supports general health research and distributes research findings and treatment guidelines with the goal of improving the quality, appropriateness, and effectiveness of healthcare services (AHRQ 2013a)
Aggregate data
Data extracted from individual health records and combined to form de-identified information about groups of patients that can be compared and analyzed
AHDI
Association for Healthcare Documentation Integrity
AHIC
American Health Information Community
Algorithmic translation
A process that involves the use of algorithms to translate or map clinical nomenclatures among each other or to map natural language to a clinical nomenclature or viceversa
Allowable charge
Average or maximum amount a third-party payer will reimburse providers for a service
All patient diagnosis-related groups (AP-DRGs)
A case-mix system developed by 3M and used in a number of state reimbursement systems to classify non-Medicare discharges for reimbursement purposes
All patient refined diagnosis-related groups (APR-DRGs)
An expansion of the inpatient classification system that includes four distinct subclasses (minor, moderate, major, and extreme) based on the severity of the patient’s illness
Alteration
Under ICD-10-PCS, a root operation that involves modifying the natural anatomic structure of a body part without affecting the function of the body part (CMS 2013)
Ambulatory care
Preventive or corrective healthcare services provided on a nonresident basis in a provider’s office, clinic setting, or hospital outpatient setting
Ambulatory care center (ACC)
A healthcare provider or facility that offers preventive, diagnostic, therapeutic, and rehabilitative services to individuals not classified as inpatients or residents
Ambulatory payment classification (APC)
Hospital outpatient prospective payment system (OPPS). The classification is a resource-based reimbursement system
Ambulatory payment classification group (APC group)
Basic unit of the ambulatory payment classification (APC) system. Within a group, the diagnoses and procedures are similar in terms of resources used, complexity of illness, and conditions represented. A single payment is made for the outpatient services provided. APC groups are based on HCPCS/CPT codes. A single visit can result in multiple APC groups. APC groups consist of five types of service: significant procedures, surgical services, medical visits, ancillary services, and partial hospitalization. The APC group was formerly known as the ambulatory visit group (AVG) and ambulatory patient group(APG)
Ambulatory payment classification (APC) relative weight
A number reflecting the expected resource consumption of cases associated with each APC, relative to the average of all APCs, that is used in determining payment under the Medicare hospital outpatient prospective payment system (OPPS)
Ambulatory surgery center (ASC) payment rate
The Medicare ASC reimbursement methodology system referred to as the ambulatory surgery center (ASC) payment system. The ASC payment system is based on the ambulatory payment classifications (APCs) utilized under the hospitalOPPS
Ambulatory surgery center or ambulatory surgical center (ASC)
Under Medicare, an outpatient surgical facility that has its own national identifier; is a separate entity with respect to its licensure, accreditation, governance, professional supervision, administrative functions, clinical services, recordkeeping, and financial and accounting systems; has as its sole purpose the provision of services in connection with surgical procedures that do not require inpatient hospitalization; and meets the conditions and requirements set forth in the Medicare Conditions of Participation
American Accreditation Healthcare Commission/URAC
A healthcare quality improvement organization that offers managed care organizations, as well as other organizations, accreditation to validate quality healthcare, and provides education and measurement programs
American Hospital Association (AHA)
The national trade organization that provides education, conducts research, and represents the hospital industry’s interests in national legislative matters; membership includes individual healthcare organizations as well as individual healthcare professionals working in specialized areas of hospitals, such as risk management; one of the four Cooperating Parties on policy development for the use of ICD-9-CM (AHA 2013)
American Medical Association (AMA)
The national professional membership organization for physicians that distributes scientific information to its members and the public, informs members of legislation related to health and medicine, and represents the medical profession’s interests in national legislative matters; maintains and publishes the CPT coding system (AMA 2013)
American National Standards Institute (ANSI)
An organization that governs standards in many aspects of public and private business; developer of the Health Information Technology Standards Panel (ANSI 2013)
American Recovery and Reinvestment Act of 2009 (ARRA)
The purposes of this act include the following: 1) To preserve and create jobs and promote economic recovery. (2) To assist those most impacted by the recession. (3) To provide investments needed to increase economic efficiency by spurring technological advances in science and health. (4) To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits. (5)To stabilize state and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases (ARRA 2009); Also called Recovery Act; Stimulus
American Society for Testing and Materials Committee E31 (ASTM E31)—Healthcare Informatics
ASTM Committee E31 on Healthcare Informatics develops standards related to the architecture, content, storage, security, confidentiality, functionality, and communication of information used within healthcare and healthcare decision-making, including patient-specific information and knowledge (ASTM 2013)
American Society for Testing and Materials Standard E1384 ASTM E1384 - 07(2013) Standard Practice for Content and Structure of the Electronic Health Record (EHR)
Identifies the basic information to be included in electronic health records and requires the information to be organized into categories (ASTM 2013)
American Standard Code for Information Interchange (ASCII)
An electronic code that converts English characters to numbers, with each letter assigned a specific number. Computers utilize this code to represent text fields, which in turn allows systems to transfer data from one computer to another
Amendment Request
Under HIPAA, an amendment of protected health information, an individual has the right to have a covered entity amend protected health information or a record about the individual in a designated record set for as long as the protected health information is maintained in the designated record set (45 CFR 164.526 2001)
Analog
Data or information that is not represented in an encoded, computer-readable format
Anatomical modifiers
Two-digit CPT codes that provide information about the exact body location of procedures, such as –LT, Left side, and –TA, Left great toe
Ancillary packaging
The inclusion of routinely performed support services in the reimbursement classification of a healthcare procedure or service
Ancillary services
- Tests and procedures ordered by a physician to provide information for use in patient diagnosis or treatment 2. Professional healthcare services such as radiology, laboratory, or physical therapy
Anesthesia death rate
The ratio of deaths caused by anesthetic agents to the number of anesthesias administered during a specified period of time
APC grouper
Software programs that help coders determine the appropriate ambulatory payment classification for an outpatient encounter
Application programming interface (API)
A set of definitions of the ways in which one piece of computer software communicates with another or a programmer makes requests of the operating system or another application; operates outside the realm of the direct user interface
Applications and data criticality analysis
A covered entity’s formal assessment of the sensitivity, vulnerabilities, and security of its programs and the information it generates, receives, manipulates, stores, and transmits
Arden syntax
A standard language for encoding medical knowledge representation for use in clinical decision support systems
Arithmetic mean length of stay (AMLOS)
The average length of stay for all patients
Assembler
A computer program that translates assembly-language instructions into machine language
Assembly language
A second-generation computer programming language that uses simple phrases rather than the complex series of switches used in machine language
Assessment completion date
According to the Centers for Medicare and Medicaid Services’ instructions, the date by which a Minimum Data Set for Long-Term Care must be completed; that is, within 14 days of admission to a long-term care facility
Assignment
An agreement between a physician and CMS whereby a physician or supplier agrees to accept the Medicare-approved amount as payment in full for services or supplies provided under Part B. Medicare pays the physician or supplier 80 percent of the approved amount after the annual $100 deductible has been met; the beneficiary pays the remaining 20 percent (CMS 2013)
Assignment of benefits
The transfer of one’s interest or policy benefits to another party; typically the payment of medical benefits directly to a provider of care
Association for Healthcare Documentation Integrity (AHDI)
Formerly the American Association for Medical Transcription (AAMT), the AHDI has a model curriculum for formal educational programs that includes the study of medical terminology, anatomy and physiology, medical science, operative procedures, instruments, supplies, laboratory values, reference use and research techniques, and English grammar (AHDI 2013)
Association of American Medical Colleges (AAMC)
The organization established in 1876 to standardize the curriculum for medical schools in the United States and to promote the licensure of physicians (AAMC 2013)
Association rule analysis (rule induction)
The process of extracting useful if/then rules from data based on statistical significance; See also rule induction
ASTM E1384
See ASTM E1384 - 07(2013) Standard Practice for Content and Structure of the Electronic Health Record (EHR)
Atlas System
A severity-of-illness system commonly used in the United States and Canada
ATM
asynchronous transfer mode
At risk contract
A type of managed care contract that provides a set fee for the care a patient is expected to receive throughout the life of the contract. Should the actual costs exceed the agreed upon contract fee, the patient continues to receive care through the end of the contract
Attestation
The act of applying an electronic signature to the content showing authorship and legal responsibility for a particular unit of information
Attributable risk (AR)
A measure of the impact of a disease on a population (for example, measuring additional risk of illness as a result of exposure to a risk factor)
Attributes
- Data elements within an entity that become the column or field names when the entity relationship diagram is implemented as a relational database 2. Properties or characteristics of concepts; used in SNOMED CT to characterize and define concepts
Audit
- A function that allows retrospective reconstruction of events, including who executed the events in question, why, and what changes were made as a result 2. To conduct an independent review of electronic system records and activities in order to test the adequacy and effectiveness of data security and data integrity procedures and to ensure compliance with established policies and procedures; See also external review
Automated clearinghouse (ACH)
An electronic network for the processing of financial transactions
Automated code assignment
Uses data that have been entered into a computer to automatically assign codes; uses natural language processing (NLP) technology—algorithmic (rules-based) or statistical—to read the data contained in a CPR
Automated forms processing technology
Technology that allows users to electronically enter data into online digital forms and electronically extract data from online digital forms for data collection or manipulation; Also called e-forms technology
Autonomy
A core ethical principle centered on the individual’s right to self-determination that includes respect for the individual; in clinical applications, the patient’s right to determine what does or does not happen to him or her in terms of healthcare
Autopsy rate
The proportion or percentage of deaths in a healthcare organization that are followed by the performance of autopsy
Available for hospital autopsy
A situation in which the required conditions have been met to allow an autopsy to be performed on a hospital patient who has died
Average daily census
The mean number of hospital inpatients present in the hospital each day for a given period of time
Average length of stay (ALOS)
The mean length of stay for hospital inpatients discharged during a given period of time; Also called average duration of hospitalization
Average payment rate (APR)
The amount of money the Centers for Medicare and Medicaid could pay a health maintenance organization for services rendered to Medicare recipients under a risk contract
Average record delinquency rate
The monthly average number of discharges divided by the monthly average number of delinquent records
Back-end speech recognition (BESR)
Specific use of SRT in an environment where the recognition process occurs after the completion of dictation by sending voice files through a server
Backscanning
The process of scanning past medical records into the system so that there is an existing database of patient information, making the system valuable to the user from the first day of implementation
Bad debt
The receivables of an organization that are uncollectible
Balance billing
A reimbursement method that allows providers to bill patients for charges in excess of the amount paid by the patients’ health plan or other third-party payer (not allowed under Medicare or Medicaid)
Balanced Budget Act (BBA) of 1997
Public Law 105-33 enacted by Congress on August 5, 1997, that mandated a number of additions, deletions, and revisions to the original Medicare and Medicaid legislation; the legislation that added penalties for healthcare fraud and abuse to the Medicare and Medicaid programs and also affected the hospital outpatient prospective payment system (HOPPS) and programs of all-inclusive care for elderly (PACE) (Public Law 105-33 1997)
Balance sheet
A report that shows the total dollar amounts in accounts, expressed in accounting equation format, at a specific point in time
Bandwidth
The range of frequencies a device or communication medium is capable of carrying
Bar chart
A graphic technique used to display frequency distributions of nominal or ordinal data that fall into categories; Also called bar graph
Baseline adjustment for volume and intensity of service
An adjustment to the conversion factor needed to fulfill the statutory budget neutrality requirement
