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RHIA Exam > RHIA Exam Prep > Flashcards

RHIA Exam Prep Flashcards

1
Q

AAAHC

A

Accreditation Association for Ambulatory Health Care - A professional organization thatoffers accreditation programs for ambulatory and outpatient organizations such as single-specialty and multispecialty group practices, ambulatory surgery centers, college/university health services, and community health centers (AAAHC 2013)

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2
Q

AAHP

A

American Association of Health Plans

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3
Q

ABN

A

Advance Beneficiary Notice - 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)

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4
Q

ADT

A

Admission - Discharge - Transfer- 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

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5
Q

ADS

A

Alternative Delivery System - A type of healthcare delivery system in which health services are provided in settings such as skilled and intermediary facilities, hospice programs, nonacute outpatient programs, and home health programs, which are more cost-effective than in the inpatient setting

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6
Q

AMA

A

Against Medical Advice or American Medical Associaton

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7
Q

ADR

A

Adverse Drug Reaction - Unintended, undesirable, or unexpected effects of prescribed medications or of medication errors that require discontinuing a medication or modifying the dose, require initial or prolonged hospitalization, result in disability, require treatment with a prescription medication, result in cognitive deterioration or impairment, are life threatening, result in death, or result in congenital anomalies (Joint Commission 2011)

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8
Q

Adverse Selection

A

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

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9
Q

ANSI

A

American National Standards Institute - An organization that governs standards in many aspects of public and private business; developer of the Health Information Technology Standards Panel (ANSI 2013)

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10
Q

APC

A

Ambulatory Payment Classification - Hospital outpatient prospective payment system (OPPS). The classification is a resource-based reimbursement system

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11
Q

OPPS

A

Outpatient Prospective Payment System - The Medicare prospective payment system used for hospital-based outpatient services and procedures that is predicated on the assignment of ambulatory payment classifications

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12
Q

ASC X12

A

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

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13
Q

BSC

A

Balanced Scorecard Metholology - A strategic planning tool that identifies performance measures related to strategic goals

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14
Q

CCD

A

Continuity of Care Document - The result of ASTM’s Continuity of Care Record standard content being represented and mapped into the HL7’s Clinical Document Architecture specifications to enable transmission of referral information between providers; also frequently adopted for personal health records

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15
Q

CCHIT

A

Certification Commission on Healthcare information Technology - An independent, voluntary, private-sector initiative organized as a limited liability corporation that has been awarded a contract by the US Department of Health and Human Services (HHS) to develop, create prototypes for, and evaluate the certification criteria and inspection process for electronic health record products

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16
Q

CON

A

Certificate of Need - A state-directed program that requires healthcare facilities to submit detailed plans and justifications for the purchase of new equipment, new buildings, or new service offerings that cost in excess of a certain amount

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17
Q

CMS

A

Centers for Medicare and Medicaid Services - The Department of Health and Human Services agency responsible for Medicare and parts of Medicaid. CMS is responsible for the oversight of HIPAA administrative simplification transaction and code sets, health identifiers, and security standards. CMS also maintains the HCPCS medical code set and the Medicare Remittance Advice Remark Codes administrative code set

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18
Q

HITECH

A

Health Information Technology for Ecomonic and Clinical Health Act - Legislation created to promote the adoption and meaningful use of health information technology in the United States. additional privacy and security requirements that will develop and support electronic health information, facilitate information exchange, and strengthen monetary penalties.Under HITECH, criteria set of guidelines (1) to establish that health information technology meets applicable standards and implementation specifications adopted by the secretary or (2) that are used to test and certify that health information technology includes required capabilities

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19
Q

CMS - 1500

A
  1. The universal insurance claim form developed and approved by the AMA and CMS that physicians use to bill Medicare, Medicaid, and private insurers for professional services provided 2. A Medicare uniform professional claim form
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20
Q

COLD

A

Computer Output to Laser Disk - Technology that electronically stores documents and distributes them with fax, e-mail, web, and traditional hard-copy print processes

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21
Q

CPOE

A

Computerized Provider Order Entry - Electronic prescribing systems that allow physicians to write prescriptions and transmit them electronically. These systems usually contain error prevention software that provides the user with prompts that warn against the possibility of drug interaction, allergy, or overdose and other relevant information

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22
Q

DEEDS

A

Data Elements for Emergency Department Systems - A set of guidelines developed by the National Center for Injury Prevention and Control data set designed to support the uniform collection of information in hospital-based emergency departments

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23
Q

Data Granularity

A

The level of detail at which the attributes and values of healthcare data are defined

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24
Q

DICOM

A

Digital Imaging and Communication in Medicine - An ISO (International Standardization Organization) standard that promotes a digital image communications format and picture archive and communications systems for use with digital images

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25
Q

E-Code

A

External Cause of Injury Code - A supplementary ICD-9-CM classification used to identify the external causes of injuries, poisonings, and adverse effects of pharmaceuticals

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26
Q

EDI

A

Electronic Data Interchange - A standard transmission format using strings of data for business information communicated among the computer systems of independent organizations

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27
Q

EOB

A

Explanation of Benefits - A statement issued to the insured and the healthcare provider by an insurer to explain the services provided, amounts billed, and payments made by a health plan. See payer remittance report

28
Q

XML

A

Extensible Markup Launguage - A standardized computer language that allows the interchange of data as structured text

29
Q

FTC

A

Federal Trade Commission - An independent federal agency tasked with dealing with two areas of economics in the United States: consumer protection and issues having to do with competition in business

30
Q

GPCI

A

Geographic Practice Cost Index - An index developed by the Centers for Medicare and Medicaid Services to measure the differences in resource costs among fee schedule areas compared to the national average in the three components of the relative value unit (RVU): physician work, practice expenses, and malpractice coverage; separate GPCIs exist for each element of the RVU and are used to adjust the RVUs, which are national averages, to reflect local costs

31
Q

GUI

A

Graphical User Interface - A style of computer interface in which typed commands are replaced by images that represent tasks (for example, small pictures [icons] that represent the tasks, functions, and programs performed by a software program)

32
Q

Hard Coding

A

The process of attaching a CPT/HCPCS code to a procedure located on the facility’s chargemaster so that the code will automatically be included on the patient’s bill 2. Use of the charge description master to code repetitive services

33
Q

HCPCS

A

Healthcare Common Procedure Coding System

34
Q

HEDIS

A

Healthcare Effectiveness Data and Information Set - A set of standard performance measures that can give you information about the quality of a health plan. You can find out about the quality of care, access, cost, and other measures to compare managed care plans. The Centers for Medicare and Medicaid Services (CMS) collects HEDIS data for Medicare plans

35
Q

HIE

A

Health Information Exchange - The exchange of health information electronically between providers and others with the same level of interoperability, such as labs and pharmacies

36
Q

HIO

A

Health Information Organization - An organization that supports, oversees, or governs the exchange of health-related information among organizations according to nationally recognized standards

37
Q

ONC

A

Office of the National Coordinator

38
Q

HSP

A

Health Information Service Provider - a vendor that supplies the data integration and connectivity services for a health information organization

39
Q

Health Integrity and Protection Data Bank

A

A database maintained by the federal government to provide information on fraud-and-abuse findings against US healthcare providers

40
Q

HL7

A

Health Level 7 - is a not-for-profit, ANSI-accredited standards-developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services

41
Q

HAC

A

Hospital Acquired Condition - the eight originally selected conditions include: foreign object retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, catheter-associated urinary tract infection, vascular catheter-associated infection, and surgical site infection—mediastinitis after coronary artery bypass graft; additional conditions were added in 2010 and remain in effect: surgical site infections following certain orthopedic procedures and bariatric surgery, manifestations of poor glycemic control, and deep vein thrombosis (DVT)/pulmonary embolism (PE) following certain orthopedic procedures

42
Q

IDS

A

Integrated Delivery System - A system that combines the financial and clinical aspects of healthcare and uses a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care

43
Q

IOM

A

Institute of Medicine
- A branch of the National Academy of Sciences whose goal is to advance and distribute scientific knowledge with the mission of improving human health

44
Q

IPO

A

Integrated Provider Organization - An organization that manages the delivery of healthcare services provided by hospitals, physicians (employees of the IPO), and other healthcare organizations (for example, nursing facilities

45
Q

IRR

A

Internal Rate of Return - An interest rate that makes the net present value calculation equal zero

46
Q

LCD

A

Local Coverage Determination - a decision by a fiscal intermediary or carrier whether to cover a particular service on an intermediary-wide or carrier-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act, which is a determination regarding whether the service is reasonable and necessary. LCDs consist only of reasonable and necessary information.

47
Q

LOINC

A

Logical Observation Identifiers, Names and Codes - A database protocol developed by the Regenstrief Institute for Health Care aimed at standardizing laboratory and clinical codes for use in clinical care, outcomes management, and research that enable exchange and aggregation of electronic health data from many independent systems

48
Q

MCO

A

Managed Care Organization - A type of healthcare organization that delivers medical care and manages all aspects of the care or the payment for care by limiting providers of care, discounting payment to providers of care, or limiting access to care; Also called coordinated care organization

49
Q

MEDPAR

A

Medicare Provider Analysis and Review -
A database containing information submitted by fiscal intermediaries that is used by the Office of the Inspector General to identity suspicious billing and charge practices

50
Q

MSN

A

Medicare Summary Notice - A summary sent to the patient from Medicare that summarizes all services provided over a period of time with an explanation of benefits provided

51
Q

MDS

A

Minimum Data Set - Document created when OBRA required CMS to develop an assessment instrument to standardize the collection of SNF patient data; the MDS is the minimum core of defined and categorized patient assessment data that serves as the basis for documentation and reimbursement in an SNF

52
Q

NCVHS

A

National Committee on Vital and Health Statistics - Established by Congress to serve as an advisory body to HHS on health data, statistics, and national health information policy. It fulfills important review and advisory functions relative to health data and statistical problems of national and international interest, stimulates or conducts studies of such problems and makes proposals for improvement to the nation’s health statistics and information systems.

53
Q

Nosocomial Infection

A

An infection acquired by a patient while receiving care or services in a healthcare organization; See also hospital-acquired infection

54
Q

OASIS

A

Outcomes and Assessment Information Set - A standard core assessment data tool developed to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs

55
Q

OBRA

A

Omnibus Budget Reconciliation Act -Federal legislation passed in 1987 that requiredthe Health Care Financing Administration (renamed the Centers for Medicare and Medicaid Services) to develop an assessment instrument (resident assessment instrument) tostandardize the collection of patient data from skilled nursing facilities

56
Q

OCR

A

Optical Character Recognition - A method of encoding text from analog paper into bitmapped images and translating the images into a form that is computer readable

57
Q

PEPPER

A

Program for Evaluation Payment Patterns Electronic Report - A benchmarking database maintained by the Texas Medical Foundation that supplies individual QIOs with hospital data to determine state benchmarks and monitor hospital compliance

58
Q

POC

A

Point of Care - The place or location where the physician administers services to the patient

59
Q

RBRVS

A

Resource-Based Relative Value Scale - A scale of national uniform relative values for all physicians’ services. The relative value of each service must be the sum of relative value units representing the physicians’ work, practice expenses net of malpractice insurance expenses, and the cost of professional liability insurance

60
Q

RAI

A

Resident Assessment Instrument

61
Q

RAP

A

Resident Assessmeent Protocol - A summary of a long-term care resident’s medical condition and care requirements, used in conjunction with the MDS to create a clear picture of the patient’s status and care plan

62
Q

SNF

A

Skilled Nursing Facility - A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, rehabilitative services but does not provide the level of care or treatment available in a hospital

63
Q

SQL

A

A fourth-generation computer language that includes both DDL and DML components and is used to create and manipulate relational databases

64
Q

FFS

A

Traditional fee-for-service reimbursement - A reimbursement method involving third-party payers who compensate providers after the healthcare services have been delivered; payment is based on specific services provided to subscribers

65
Q

X12

A

An ANSI-accredited group that defines EDI standards for many American industries, including healthcare insurance. Most of the electronic transaction standards mandated or proposed under HIPAA are X12 standards

66
Q

ZPIC

A

Zone Program Integrity Contractor -A CMS program that replaces the Medicare Program Safeguard Contractors (PSCs). ZPICs are responsible for detection and prevention of fraud, waste, and abuse across all Medicare claim types by performing medical reviews, data analysis, and auditing (CMS 2012)

RHIA Exam (1 decks)

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