question

medical necessity

answer

treatment that is in accordance with generally accepted medical practice

question

electronic medical record

answer

computerized record of one physicians encounters with a patient over time

question

health information technology

answer

using computers and electronic communications to manage medical information. ex: sharing pt records with physicians outside the physicians own medical group, transmitting Rx to phamramcy's and ordering tests from an outside labs.

question

revenue cycle management

answer

oversight of the activities associated with a patient encounter to ensure that the provider receives full payment for services

question

certification

answer

nationally recognized designation that acknowledges that an individual has mastered a standard body of knowledge and meets certain competencies

question

patient examination

answer

an examination of a person's body in order to determine his or her state of health

question

pay for performance (P4P)

answer

provision of financial incentives to physicians who provide evidence-based treatments to their patients

question

ARRA

answer

federal act that provides financial incentives for adoption of electronic health records

question

practice management program

answer

program used to perform admin. and financial functions in a medical office

question

electronic health record

answer

computerized lifelong health care record with data from all sources

question

are practice management programs designed to manage patients clinical records?

answer

NO

question

what do integrated PM/EHR programs do?

answer

increase patient safety, improve quality of care and reduce operating costs

question

is the ambulatory care medical record a log of a patients hospitalizations?

answer

no, ambulatory is for outpatients not overnight stays

question

can medical records be used to protect physicians from accusations of malpractice?

answer

yes, because all documentation regarding the care and treatment of a patient will be in the records and can be used as a legal document.

question

when are the patients eligibility for insurance benefits verified?

answer

during the second step of the medical documentation and billing cycle

question

what program is used to monitor the status of claims that have been sent out to health plans?

answer

practice management programs

question

who maintains personal health records?

answer

the patient

question

who maintains EHR's?

answer

the physician

question

what is the federal law that protects patient's private health information, ensures coverage during job changes, and uncovers fraud and abuse?

answer

HIPAA

question

should diagnosis' be included in medical office records for patients?

answer

yes

question

what are some of the concerns when implementing an EHR in a physicians practice?

answer

1. changes to the practice's workflow 2. cost 3. the inability to share information due to lack of clinical standards

question

what is the purpose of managing the revenue cycle?

answer

cash flow

question

what are practice management programs used for?

answer

to manage payments from payers electronically

question

what type of health record contains information that may be entered by a number of physicians and other providers?

answer

EHR

question

A/R

answer

accounts receivable

question

EMR

answer

electronic medical record

question

HIE

answer

health Information exchange

question

HIT

answer

health information technology

question

NHIN

answer

national health information network - is a set of standard services and policies that enable the secure exchange of health information over the internet.

question

PM

answer

practice management

question

RCM

answer

revenue cycle management

question

list the 10 steps in the medical documentation cycle.

answer

1. preregister patient 2. establish financial responsibility 3. check in patient 4. review coding compliance 5. billing 6. check out patient 7. prepare and transmit claims 8. monitor payer adjudication 9. generate patient statements 10. follow up on patient payments and collections

question

health informatics

answer

knowledge required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine

question

Physician quality reporting initiative (PQRI)

answer

a medicare program that gives bonuses to physicians when they use treatment plans and clinical guidelines that are based on scientific evidence

question

meaningful use

answer

the utilization of certified EHR to improve quality, efficiency, and patient safety in the health care system

question

integrated PM/EHR programs

answer

programs that share and exchange demographic information, appointment schedules, and clinical data

question

medical record

answer

a chronological health care record that includes information that the patient provides, such as medical Hx, as well as the physician's assessment, Dx and TP

question

continuity of care

answer

coordination of care received by a patient over time and across multiple health care providers

question

medical malpractice

answer

the provision of medical services at a less than acceptable level of professional skill that results in injury or harm to a patient

question

diagnosis code

answer

a code that represents the physicians determination of a patients primary illness

question

procedure code

answer

a code that represents the particular service, treatment, or test provided by a physician

question

data wharehouse

answer

a collection of data that includes all areas of an organizations operations

question

data mining

answer

the process of analyzing large amounts of data to discover patterns or knowledge

question

record retention schedule

answer

a plan for the management of records that lists types of records and indicates how long they should be kept

question

must retention schedules comply with state and federal laws?

answer

yes

question

how long are physician's required to maintain medical records?

answer

for 7 years, some states including Hawaii require them to be maintained for 25 years

question

how long should laboratory pathology tests be retained for?

answer

10 years

question

what are the medical billers responsibilities?

answer

1. verify pt insurance info and eligibility 2. collect payments 3. maintain up to date info about a health plans billing guidelines 4. follow federal, state, and local regulations on maintaining the confidentiality of information about patients 5. abstracting info from patients records for accurate billing 6. billing health plans and patients 7. assist pts with insurance info 8. processing payments 9. maintaining financial records 10. updating forms and computer systems the practice uses for pt info. and health care claims processing

question

what are the eight facts that are documented in the medical record for an ambulatory patient encounter?

answer

1. patients name 2. encounter date and reason 3. appropriate history and physical examination 4. review of all tests that were ordered 5. diagnosis 6. plan of care, or notes on procedures or treatments that were given 7. instructions or recommendations that were given to the patient 8. signature of the provider who saw the patient

question

what are the four functions of a PMP that relate to manageing claims?

answer

1. creating electronic claims 2. monitoring clims status electronically 3. receiving notification of electronic payments 4. handling electronic payments

question

what are the responisbilities of the clinical staff?

answer

provide treatment for patients

question

what are the responibilities of the administrative staff?

answer

they manage the business aspects of health care, they work behind the scenes in a medical office and do not provide medical treatment or testing.

question

what its the goal of HIE?

answer

facilitate access to clinical information for the purpose of providing quality care to patients.

question

what are the 8 core functions of the EHR?

answer

1. Health Info & data element - pt demographic info 2. results management - access to current & past labs & tests results 3. order mgt - ability to send, receive & store orders for medications, tests and other services 4. decision support 5. electronic communication & conncectivitiy - ability for health plans/providers to access info 6. patient support 7. administrative processes - procedure codes and Dx codes enterd by physician in the EHR are transmitted electronically to PMP where coding specialist reviews them 8. reporting & population management

question

Electronic Funds Transfer (EFT)

answer

electronic payments sent directly to the providers bank

question

the info needed to create a claim is found on what 2 documents?

answer

patient information form and encounter form

question

ajudication

answer

when then payer receives the claim, it goes through a series of steps designed to determine whether the claim should be paid.

question

how is the A/R information important to a practice?

answer

helps practice decide whether to buy or lease new equipment, adopt new technology, expand to a larger office, add staff etc.

question

MIPAA

answer

Medicare Improvements for Patients and Providers Act 2008 - provides financial incentives to practioners who use e-prescribing, it enables them to transmit Rx electronically to a patients pharmacy

question

what does e-prescribing eliminate?

answer

RX errors caused by illegible handwriting and electronically checks for drug interactions and allergies

question

MIPAA requires e-prescribing by what year? If providers fail to do so, what happens?

answer

2011. They reduce payments to providers who fail to e-prescribe

question

what year did George W. Bush recommend greater use of IT in health care? And by what year should EHR be established by?

answer

2004 and 2014

question

REC - regional extensions centers

answer

offer information, guidance, training and support services to PCP who are in the process of making the transition to an EHR system.

question

integrated PM/EHR program

answer

can share and exchange demographic info., appointment schedules and clinical data, so info does not have to be entered twice, once in PMP and secondly in EHR.

question

what are the benefits of integrated PM/EHR programs?

answer

increases pt safety, improves the quality of pt care and reduces operating costs.

question

encounter AKA visit?

answer

the meeting of the patient and the physician or other medical professional for the purpose of providing health care.

question

preventative care

answer

care to keep diseases from occurring or to enable early detection and treatment. ex: routine physical, immunizations, screening tests and behavioral counseling.

question

acute care

answer

provided for illnesses with sudden onset that are time limited - not expected to continue for more than a few days or weeks, such as the recovery for a broken bone.

question

chronic illness

answer

Must be treated over the long term. On-going medical treatment for a lengthy period of time, in many cases for a life time. ex: heart disease, diabetes, asthma, AIDS.

question

Personal Health information (PHR)

answer

are private, secure electronic files that are created, maintained and owned by the patient

question

what do PHR's contain?

answer

current medicines and dosages, Health information, immunization records, allergies, medical test results, past surgeries, and family medical history.

question

compliance officer

answer

often the physician or practice manager - investigates and resolves all compliance issues pertaining to coding, billing, documentation and reimbursement.

question

is the administrative staff soley responsible for collecting payment for services?

answer

NO - all personnel both admin. and clinical play key roles. each must commuincate critical information to other staff members for reimbursement to occur.

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