...Definition of Terms Paper Definition of Terms Paper In today’s health care environment patient safety has become one of the most important objectives in all health care institutions. One of the main issues when it comes to safety of patients is errors that can occur when abbreviations are not used properly when dealing with health information technology. It is important for health care employees to have knowledge and a clear understanding of what the abbreviations stand for, as well as the purpose of them. When dealing with a patient’s personal information that concerns their medical history, there must be the use of accurate written or computerized documentation at all times. This paper will define the following abbreviations: AMR, CMR, CMS, CMS 1500, CPT, DRG, EPR, HL7, ICD-9, UB-2, and the important role each plays in health care information technology. AMR The abbreviation AMR refers to what is known as Automated Medical Records. An Automated Medical Records system is used to record all information concerning a patient’s care from the initial consultation, the admission into the hospital if applicable, any treatment involved and medications dispensed, to the final billing (Pinkerton, 2006).When an AMR is used the amount of paperwork associated with a health care practice or hospital can be lessened. Automated patient information has the capability to provide health care workers and organization with patient information that can be critical when treating them. The information...
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...safeguards the exchange between government, quality entities, customers, suppliers and insurers. Health Information Technology is now viewed as a very promising agent for enhancing healthcare quality, protection and a well-organized and resourceful healthcare delivery system. This assignment has ten terms that fall under the scope of HIT and Health Information Systems (HIS) that are interconnected. Each term will be defined and a concise statement of importance will be explained. AMR • AMR (Automated Medical Records) is a term used at the early stage of electronic medical documentation. It was information retained on a customary personal computer and did not comply with legal ramifications for electronic medical records. Therefore a paper file was maintained. The computer information is used as a working file, and then pages are printed and filed in the chart (Fishman, 2005). • Important aspect of AMR is the aid of premature discovery of conditions of public health issues. For instance, seasonal respiratory illness or atypical occurrences, like bioterrorist attack that initially exhibit as respiratory symptoms. Knowledge of disease patterns in real time may also help clinicians to manage patients (Ross, L., Kleinman, K., Dashevsky, I., DeMaria, A. and Platt,R., 2001). CMR • CMR (Computerized Medical Records) was the first attempt in an automated, on-line medical record system. It contains clinical and demographic...
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...new technologies. The medical technology industry is a 150 to 200 billion industry. Prescription drugs, government regulation, malpractice liability and the aging of the largest generation birthed in the U.S., the Baby Boomers (78 million). Every day in the U.S., 10,000 Baby Boomers reach age 60, putting greater demands on medical services. Chronic diseases, many preventable (diabetes, cancers of the lung and cardio vascular disorders) also contribute to escalating cost of health care. Acronyms reduce the amount of data needed to convey messages which result in the reduced time and labor required to produce documentation in the field of health care. The following are common acronyms characteristic of the language of health care. The CMS-1500 is a remittance claim form from the Centers for Medicare and Medicaid Services that...
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...HIPPA Joe Smith Independence University HCA 542A Mod 11:2011 8wk-online Final Paper October 10, 2011 HIPPA This paper will begin with a brief background and history on the Health Insurance Portability and Accountability Act (HIPAA). Following the background will be details about issues that are address within the Health Insurance Portability and Accountability Act. The purpose of this paper is to provide a foundation with providing some information about HIPAA. Background The Health Insurance Portability and Accountability Act (HIPAA) was enacted by Congress in 1996 in response to several issues facing health care coverage, privacy, security and fraud in the United States (ALL THINGS MEDICAL BILLING, 2011, para. 2). Before HIPAA, rules and regulations varied by state, there was no real consistency. Also, there was confusion as to which regulations were applicable and to whom. Did the rules apply in the states where the organization was doing business or where the organization was based? There was also no uniformity between state and federal requirements (ALL THINGS MEDICAL BILLING, 2011, para. 3). With regard to privacy, there were numerous uncoordinated federal acts which addressed privacy in some form. Prior to HIPAA, there was no standard authority for enforcement of fraud and abuse that applied to state and federal health care programs (ALL THINGS MEDICAL BILLING, 2011, para. 4). Congress recognized the increased use...
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...Health care Fraud Health care fraud is a crime that has a significant effect on the private and public health care payment system. According to the Federal Bureau of Investigation, all health care programs are subject to fraud with Medicare and Medicaid being the most visible. It is estimated that fraudulent billings to both private and public health care programs are between 3 and 10 percent of total health care programs expenditures. The most recent Centers for Medicare and Medicaid (CMS) statistical estimates project that total health care expenditures are estimated to total $2.4 trillion, representing 14 percent of the gross domestic product. By the year 2016, CMS also estimates that by the year 2016, the total health care spending is to exceed $4.14 trillion, representing 19.6 percent of the GDP. As one can see, the tens of billions of dollars lost due to health care fraud is a serious financial issue that affects the healthcare system as a whole and affects patients, taxpayers, and government through higher health care costs, insurance premiums and taxes. Health care fraud is defined in Title 18, United States Code (U.S.C) s. 1347 as “whoever knowing and willfully executes or attempts to execute a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations or promises, any money or property owned by or under the custody or control of, any health care benefit program.” In other words, it is intentional...
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...#1…Public health IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care...
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...in the New Tampa area in 1990*. Currently it employs 3 physicians, one nurse practitioner, one nurse and two staff assistants. It provides services to more than 1500 patients and last year had 4000 patient visits. When the practice first opened, each patient’s chart included a double-sided standard sheet of paper created for each visit, test results, images, progress notes, prescribed medication and demographics information. The size of these charts has been increased exponentially since then and in 2009 the practice has decided to move forward with an EMR implementation. The practice has been using an electronic billing and scheduling system for years, however the personnel was skeptical for the EMR implementation since an unsuitable system could destroy the continuity of the patient’s medical record, incur additional costs and disrupt patient care and staff function. A committee comprised of one physician, the nurse and one staff assistant was formed to define the EMR requirements. Unfortunately, the practice did not have a budget for IT support. Luckily, the nurse had training in nursing informatics and became the internal IT consultant. After extensive research, the committee decided to invite two vendors for an onsite demonstration and finally selected one for the...
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...advances in natural language processing, EHR adoption, compliance issues and mandates for labor – intensive administrative reporting processes reduction, influenced the demand of CAC. Traditionally, clinical documentation (whether paper or electronic) is analyzed by a coder, translated into the appropriate ICD – 9 CM or CPT/HCPCS codes with the help of coding books or encoders and entered into a database. These new coding automation tools assists HIM professionals in translating data by automated code assignment instead of manual review and translation alone. As early as the 1950s, the technology of CAC – enabled tools, particularly Natural Language Processing (NLP), started with formal language theory. Throughout this time, technological progress was slow but technology has rapidly progressed and is constantly advancing at an exponential rate since the 1990s. Coding is a difficult task because it has a four- dimensional complexity. First, coding rules’ volume and intricacy makes selecting the right diagnosis/ procedure code and code modifiers difficult. In an article by Yuval Lirov (2009), the author gives example to this level of complexity by stating, “ For instance, a claim will get denied if you charged for two CPT codes but provided an ICD – 9 code...
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...abbreviation that also indicates edition, such as DSM-IV-TR, which indicates fourth edition, text revision of the manual, published in 2000. The DSM-IV-TR provides a classification of mental disorders, criteria sets to guide the process of differentialdiagnosis , and numerical codes for each disorder to facilitate medical record keeping. The stated purpose of the DSM is threefold: to provide "a helpful guide to clinical practice"; "to facilitate research and improve communication among clinicians and researchers"; and to serve as "an educational tool for teaching psychopathology." The multi-axial system The third edition of DSM , or DSM-III , which was published in 1980, introduced a system of five axes or dimensions for assessing all aspects of a patient's mental and emotional health. The multi-axial system is designed to provide a more comprehensive picture of complex or concurrent mental disorders. According to the DSM-IVTR, the system is also intended to "promote the application of the biopsychosocial model in clinical, educational and research settings." The reference to the biopsychosocial model is significant, because it indicates that the DSM-IV-TR does not reflect the view of any specific "school" or tradition within psychiatry regarding the cause or origin (also known as "etiology") of mental disorders. In other words, the DSM-IV-TR is atheoretical in its approach to diagnosis and classification— the axes and categories...
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...accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. HIPAA Colloquial acronym(s) Enacted by the 104th United States Congress Citations Public Law Stat. Pub.L. 104–191 110 Stat. 1936 [1] [2] Legislative history [3] • • • • • • • • • Introduced in the House as H.R. 3103 [4] by Bill Archer (D-TX) on March 18, 1996 [5] Committee consideration by: House Ways and Means Passed the House on March 28, 1996 (267–151 Passed the Senate on April 23, 1996 (100-0 [6] ) [7] ) [8] ) and by the Senate on , in lieu of S. 1028 Reported by the joint conference committee on July 31, 1996; agreed to by the House on August 1, 1996 (421–2 [9] August 2, 1996 (98–0 ) Signed into law by President Bill Clinton on August 21, 1996 e v t [10] The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191 [1], 110 Stat. 1936 [2] , enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It has been known as the Kennedy–Kassebaum Act or Kassebaum-Kennedy Act after two of its leading sponsors.[11] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative...
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...HIM141 Test 4 Chapters 8-10 Please completely answer the following questions. 1. What is the MPI and what types of information are contained in the MPI? MPI-master patient index, sometimes called a master person index, link a patient’s medical record number with common identification data elements, for example: patient’s complete name, date of birth, gender, mother’s maiden name and social security number. Because most health care facilities house patient records according to a medical record number, the MP becomes the key to locating paper based records in the health information department file system. Thus, the MPI is retained permanently because it serves as the key to finding the patients record, it can be automated or manual. According to the American Health Information Management Association (AHIMA), some recommended core data elements for indexing and searching records include: * Internal patient Identification * Patient Name * DOB * DOB qualifier * Gender * Race * Ethnicity * Address * Alias/pervious name * SS# * Facility identification * Universal patient identifier (if available) * Account number * Admission date * Discharge date * Service type * Patient disposition 2. What are registers and indexes? Registers and registries contain information about a disease or event and are maintained by individual health care facilities, federal and state government agencies and private organizations...
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...APPENDIX Checklists A Checklist A-1 Reviewing a Budget 1. Is this budget static (not adjusted for volume) or flexible (adjusted for volume during the year)? 2. Are the figures designated as fixed or variable? 3. Is the budget for a defined unit of authority? 4. Are the line items within the budget all expenses (and revenues, if applicable) that are controllable by the manager? 5. Is the format of the budget comparable with that of previous periods so that several reports over time can be compared if so desired? 6. Are actual and budget for the same period? 7. Are the figures annualized? 8. Test one line-item calculation. Is the math for the dollar difference computed correctly? Is the percentage properly computed based on a percentage of the budget figure? 333 334 APPENDIX A Checklists Checklist A-2 Building a Budget 1. What is the proposed volume for the new budget period? 2. What is the appropriate inflow (revenues) and outflow (cost of services delivered) relationship? 3. What will the appropriate dollar cost be? (Note: this question requires a series of assumptions about the nature of the operation for the new budget period.) 3a. Forecast service-related workload. 3b. Forecast non–service-related workload. 3c. Forecast special project workload if applicable. 3d. Coordinate assumptions for proportionate share of interdepartmental projects. 4. Will additional resources be available? 5. Will this budget accomplish the appropriate managerial objectives for...
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...new74598_ch01_001-024.indd Page 1 24/09/12 1:18 PM user-f502 /202/MH01799/new74598_disk1of1/0073374598/new74598_pagefiles FROM PATIENT TO PAYMENT: UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) ...
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...trademarks or service marks used herein are the property of their respective owners. HP Enterprise Services is an equal opportunity employer and values the diversity of its people. © 2010 HP Enterprise Services. All rights reserved. Contents Introduction 3 Eligibility 4 Restricted Aid Categories 4 All Arkansas Medicaid Aid Categories 6 Therapy Benefits 10 Program Coverage 12 Prior Authorization Request Procedures for Augmentative Communication Device (ACD) 15 Evaluation 15 Contact List for Reviews, Managed Care and Authorizations 16 National Place of Service Codes 18 Quick Tips for Submitting Claims 19 Introduction to Billing 19 CMS-1500 Billing Procedures - Occupational, Physical, Speech Therapy Procedure Codes 19 Augmentative Communication Device (ACD) Évaluation 22 Billing Instructions - Paper Only 22 Completion of the CMS-1500 Claim Form 22 Special Billing Procedures 29 Common Billing Errors 30 Brief Overview of Benefits 31 Contact Information 32 Introduction This Billing Tips document serves as a training supplement for Arkansas Medicaid providers but does not supersede official program documentation including: Arkansas Medicaid provider manuals, Official Notices and transmittal letters published by the Division of Medical Services and distributed by HP Enterprise Services. This document focuses on Arkansas Medicaid eligibility and billing issues and incorporates the following quick reference items...
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...Method vs. Prototype 14-15 The Phases of the Waterfall Method 15-16 Section 5: Information Systems and Society 17 History of Hacking 17 Techniques and Approaches Hackers Use 17-19 Preventive Measures for Minimizing Hacker Disruption 19-20 References 21-24 Section 1: Information Systems Overview The CDC Organizations use information systems for a multitude of reasons. Some of these reasons can be to increase the quality of healthcare and improve the overall health care industry, such as does the Centers for Disease Control and Prevention. CDC is well known for collecting data on a vast spectrum of information in order to improve the quality and the way health care is delivered. By conducting research and investigations, CDC continues to increase the security of health of our nation. Since opening its doors in 1946, CDC has been in the business of prevention and control of diseases, injury, and disability for more than 60 years (Centers for Disease Control and Prevention, 2013). In...
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