Ch3 Vocab

Question 1

Accreditation organization

Answer 1

a professional organization that establishes the standards against which healthcare organizations are measured and conducts periodic assessments of the performance of individual healthcare organizations

Question 2

Advanced Decision support

Answer 2

Data driven intelligence that makes the clinical guidelines and research findings available to physicians at a click

Question 3

Biomedical research

Answer 3

the process of systematically investigating subjects related to the functioning of the human body

Question 4

case management

Answer 4

1 a process used by a doctor, nurse, or other health professional to manage a patents healthcare. 2 the ongoing, concurrent review performed by clinical professionals to ensure the necessity and effectiveness of the clinical services being provided to a patient

Question 5

Case-mix analysis

Answer 5

a method of grouping patients according to a predefined set of characteristics

Question 6

Centers for Disease Control and Prevention (CDC)

Answer 6

a federal agency dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability Committed tgo programs that reduce the health and economic consequences of the leading causes of death and disability, thereby ensuring a long, productive, healthy life for all people

Question 7

Certificate of destruction

Answer 7

a document that constitutes proof that a health record was destroyed and that includes the method of destruction, the signature of the person responsible for destruction and inclusive dates for destruction

Question 8

Certification

Answer 8

the act of granting approval for a healthcare organization to provide services to a specific group of beneficiaries; also, the act of granting a healthcare professional approval to practice medicine

Question 9

CLinical practice guidelines

Answer 9

the established criteria against which the decisions and actions of healthcare practitioners and other representatives of healthcare organizations are assessed in accordance with state and federal laws, regulations, and guidelines; the codes of ethics published by professional associations or societies; the criteria for accreditation published by accreditation agencies; of the usual and common practice of similar clinicians or organizations in a geographical region

Question 10

Clinical privilege

Answer 10

the authorization granted by a healthcare organization’s governing board a member of the medical staff that enables the physician to provide patient services in the organization within specific practice limits

Question 11

Clinical trials

Answer 11

1 one of the final stages of a long and careful research process to help patients live longer, healthier lives; je;p doctors and researchers find better ways to prevent, diagnose, or treat diseases 2. experimental study in which an intervention or treatment is given to one group in a clinical setting and the outcomes compared with a control group that did not have the same intervention or treatment or that had a different intervention or treatment

Question 12

Confidentiality

Answer 12

1 a legal and ethical concept that establishes the healthcare provider’s responsibility for protecting health records and other personal and private information from unauthorized use or disclosure. 2 as amended by HITECH, the practice that data or information is not made available or disclosed to authorized or processes

Question 13

Continuous quality improvement (CQI)

Answer 13

1 a management philosophy that emphasizes the importance of knowing and meeting the customer expectations, reducing variation within process, and relying on data to build knowledge for process improvement. 2 a component of total quality management that emphasizes ongoing performance assessment and improvement planning

Question 14

Core measure

Answer 14

Standardized performance measures developed to improve the safety and quality of healthcare

Question 15

Corporate negligence

Answer 15

the failure of an organization to exercise the degree of care considered reasonable under the circumstances that resulted in an unintended injury to another party

Question 16

Court Order

Answer 16

an official direction issued by a court judge and requiring or forbidding specific praties to perform specific actions

Question 17

Credentialing

Answer 17

the process of reviewing and validating the qualifications of physicians and other licensed independent practitioners, for granting medical staff membership to provide patient care services

Question 18

Data

Answer 18

the dates, numbers, images, symbols, letters, and words that represent basic facts and observations about people, processes, measurements, and conditions.

Question 19

Demographic data

Answer 19

Data that describe the characteristics of enrollee populations within a managed care entity. Demographic data include but not limited to age, sex, race to ethnicity, and primary language.

Question 20

e-Discovery

Answer 20

Refers to Amendments to Federal Rules of Civil Procedure and Uniform Rules relating to discovery of electronically stored information; wherein audits trails. the source code of the program, metadata, and nay other electronic information that is not typically considered the legal health record is subject to motion for compulsory discovery

Question 21

Federal Rules of Civil Procedure (FRCP)

Answer 21

Rules established by the US Supreme court setting the “rules of the road” and procedures for federal court cases, FRCP includes electronic records and continue to be very important as benchmarks in how these records can be used in courts, not only federal, but state and other courts as well

Question 22

Financial data

Answer 22

the data collected for the purpose of managing the assets and expenses of a business; in healthcare, data derived from the charge generation documentation associated with the activities of care and then aggregated by specific customer grouping for financial analysis

Question 23

Incident

Answer 23

an event that is considered inconsistent with accepted standards of care

Question 24

Informed Concent

Answer 24

1 a legal term referring to a patient’s right to make their own treatment decisions based on the knowledge of the treatment to be administered or the procedure to be performed 2 an individual’s voluntary agreement to participate in research or to undergo a diagnostic, therapeutic, or preventative medical procedure.

Question 25

Liability

Answer 25

1 a legal obligation or responsibility that may have financial repercussions if not fulfilled 2 an amount owed by an individual or organization to another individual or organization

Question 26

Loss prevention

Answer 26

a risk management strategy that includes developing and revisiting policies and procedures that are both facility-wide and department specific

Question 27

Loss reduction

Answer 27

a component of a risk management program that emcompasses techniques used to manage events or claims that already have taken place

Question 28

Medical necessity

Answer 28

1 The likelihood that a proposed healthcare service will have a reasonable beneficial effect on the patient’s physical condition and quality of life at a specific point in their illness or lifetime. 2 As amended by HITECH, a covered entity or business associate may not use or disclose protected health information, except as permitted or required, 3 the concept that procedures are only eligible for reimbursement as a covered benefit when they are performed for a specific diagnosis or specified frequency

Question 29

Medical staff bylaws

Answer 29

Standards governing the practice of medical staff members; typically voted upon by the organized medical staff and the medical staff executive committee and approved by the facility’s board; governs the business conduct, rights, and responsibilities of the medical staff; medical staff members must abide by these bylaws in order to continue to practice in the healthcare facility

Question 30

Morbidity

Answer 30

a diseased state, often used in the context of a morbidity rate, In common clinical usage any disease state, including diagnosis and complication, is referred to as morbidity.

Question 31

Mortality

Answer 31

1 The incidence of death in a specific population 2 the loss of subjects during the course of a clinical research study

Question 32

National Vital Statistics Systems (NVSS)

Answer 32

the oldest and most successful example of intergovernmental data sharing in public health, and the shared relationships. standards, and procedures that form the mechanism by which NCHS collects and disseminates the nation’s official vital statistics. these data are provided through contracts between NCHS and vital registration systems operated in the carious jurisdictions and legally responsible for the registration of vital events-births, deaths, marriages, divorces, and fetal deaths.

Question 33

Pay for performance

Question 34

Performance improvement (PI)

Answer 34

the continuous study and adaptions of a healthcare organization’s functions and processes to increase the likelihood of achieving desired outcomes

Question 35

Population-based statistics

Answer 35

Statistics based on a defined population rather than on a sample drawn from the same population

Question 36

Redisclosure

Answer 36

The release, transfer, provision of access to, of divulging in any other manner of patient health information that was generated by an external source to others outside of the organization and its workforce members

Question 37

Reimbursement

Answer 37

Compensation or repayment for healthcare services

Question 38

Risk Management (RM)

Answer 38

A comprehensive program of activities intended to minimize the potential for injuries to occur in a facility and to anticipate and respond to ensuring liabilities for those injuries that do occur. The process in place to identify, evaluate, and control risk, defined as the organization’s risk of accidental financial liability

Question 39

Risk Prevention

Answer 39

Developing early warning and reporting programs, providing training on safety and adverse occurrences, creating databases to track events, and performing similar activities

Question 40

Statute of limitations

Answer 40

A specific time frame allowed by a statute or law for bringing litigation

Question 41

Subpoena

Answer 41

A command to appear at a certain time and place to give testimony on a certain matter

Question 42

Subpoena duces tecum

Answer 42

A written order commanding a person to appear, give testimony, and bring all documents, papers, books, and records described in the subpoena. The devices are used to obtain documents during pretrial discovery and to obtain testimony during trial

Question 43

Third-party payer

Answer 43

An insurance company or healthcare program that pays or reimburses healthcare providers or patients for the delivery of medical services

Question 44

Transcriptionist

Answer 44

A specialty trained typist who understands medical terminology and translates physicians’ verbal dictation into written reports

Question 45

Unique identifier

Answer 45

A combination of numbers of alphanumeric characters assigned to a particular patient

Question 46

Utilization management (UM)

Answer 46

1. The collection of systems and processes to ensure that facilities and resources, both human and nonhuman, are used maximally and are consistent with patient care needs. 2 A program that evaluates the healthcare facility’s efficiency in providing necessary care to patients in the most effective manner; formerly known as utilization review

Question 47

Utilization review (UR)

Answer 47

A formal process conducted to determine the medical necessity of the services provided to, or planned for, an individual patient.

Question 48

World Health Organization (WHO)

Answer 48

The United Nations specialized agency created to ensure the attainment by all peoples of the highest possible levels of health; responsible for a number of international classification, includinging ICD-10 ICF