question

abstracting

answer

data entry of codes and other pertinent information utilizing computer software

question

accreditation

answer

voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law

question

ACGME

answer

Accreditation Council for Graduate Medical Education; professional organization responsible accrediting medical training programs in the US through a peer review process that is based on established standards and guidelines

question

active

answer

medical staff member who delivers most hospital medical services and performs significant organizational and administrative medical staff duties

question

agenda

answer

listing of all items of business to be discussed at a committee meeting

question

American Recovery and Reinvestment Act

answer

legislation that authorized 1.5 billion dollars in grants for construction, renovation, and equipment, and for the acquisition of health information technology systems; included HITECH Act

question

HITECH

answer

Health Information Technology for Economic and Clinical Health Act; established Office of National Coordinator for Health Information Technology within HHS to improve health care quality, safety and efficiency

question

associate

answer

medical staff member whose advancement to active category is being considered

question

biometrics

answer

identifier that measurers a borrower's unique physical characteristics, such as fingerprints, hand or face geometry, retinal scan, or handwritten signature, and compares it to a stored digital template to authenticate the identity of the borrower

question

board of directors

answer

membership serves without pay and is represented by professionals from the business community; has ultimate legal authority and responsibility for the hospital's operation and is responsible for the quality of care administered to patients; also called governing board, board of governors, board of trustees

question

bylaws

answer

rules that delineate medical staff responsibilities

question

CMS

answer

Centers for Medicare and Medicaid Services; DHHS agency that administers Medicare, Medicaid, and the SCHIP; formerly called the Health Care Financing Administration (HCFA)

question

chief resident

answer

position held by a physician in the final year of residency or in the year after the residency has been completed; plays a significant administrative or teaching role in guiding new residents

question

CFR

answer

Code of Federal Regulations; codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government

question

coding

answer

assigning numeric and alphanumeric codes to diagnoses, procedures, and services; usually performed by credentialed individuals

question

consulting medical staff

answer

highly qualified practitioner who can provide a wide variety of education background, knowledge or skills

question

continuum of care

answer

complete range of programs and services, with the type of health care indicating the health care services provided

question

contract services

answer

arranging with outside agencies to perform certain functions, such as health information services, housekeeping, medical waste disposal and clinical services

question

courtesy medical staff

answer

medical staff member who admits an occasional patient to the hospital

question

CPT

answer

Current Procedural Terminology; published by the AMA; codes are five-digit numbers assigned to ambulatory procedures and services

question

deemed status

answer

hospitals that are accredited by approved accreditation organizations (eg, Joint Commission) are determined to have met or exceeded Conditions of Participation to participate in the Medicare and Medicaid programs

question

deeming authority

answer

when an accrediting authority organization's standards have met or exceeded CMS Conditions of Participation for Medicare certification, accredited facilities are eligible for reimbursement under Medicare and Medicaid and CMS is less likely to conduct an on-site survey of it's own

question

Deficit Reduction Act of 2005

answer

created the Medicaid Integrity Program which is a fraud and abuse detection program

question

Conditions of Participation

answer

regulations that health care organizations must meet in order to participate in and be reimbursed by CMS Medicare and Medicaid programs

question

digital signature

answer

type of electronic signature that uses public key cryptography; created using public key cryptography to authenticate a document or message

question

disaster recovery plan

answer

ensures appropriate response to internal and external disasters

question

DNR

answer

do not resuscitate; order documented in the patient's medical record which instructed nursing and medical staff no to try to revive the patient if breathing or heartbeat stops

question

EHR

answer

electronic health record; automated record system that contains a collection of information documented by a number of providers at different facilities regarding one patient; includes unique patient identifier and accurate health problems, status, and treatment data for health care providers

question

electronic signature

answer

encompasses all technology options available that can be used to authenticate a document, including the name typed at the end of an email, digitized signature, or PIN

question

EMTALA

answer

Emergency Medical Treatment and Labor Act; antidumping statute; addresses the problem of hospitals failing to screen or treat, or transferring patients by establishing criteria fro the discharge and transfer Medicare and Medicaid patients

question

Federal Register

answer

legal newspaper published every business day by the National Archives and Records Administration (NARA)

question

NARA

answer

National Archives and Records Administration; published Federal Register daily

question

for-profit

answer

businesses in which excess income is distributed to shareholders and owners

question

government-supported hospitals

answer

not-for-profit, supported by local, regional, or federal taxes and operated by local, state and federal governments; also called public hospitals

question

HCPCS Level II (National) codes

answer

developed by the Centers for Medicare & Medicaid Services and used to classify report procedures and services; codes are reported to third-party payers (insurance companies) for reimbursement purposes

question

third-party payers

answer

an organization that processes claims for reimbursement covered by a health care plan, eg, insurance companies

question

HCPCS

answer

Health Care Procedure Coding System; comprised of Level I (CPT) and Level II (National) codes

question

health care proxy

answer

legal document in which the patient chooses another person to make treatment decisions in the event the patient becomes incapable of making these decisions

question

HIPDB

answer

Health Care Integrity and Protection Data Bank; created as part of HIPAA to combat fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioner's, provider's, or supplier's past actions

question

HIPAA

answer

Health Care Portability and Affordability Act; mandated administrative simplification regulations that govern privacy, security, and electronic transactions standards for health care information; also protects health insurance coverage for workers and their families when they change or lose their jobs

question

COBRA

answer

Consolidated Omnibus Budget Reconciliation Act of 1985; allows former employers, retirees, spouses, domestic partners, and eligible dependent children who lose coverage due to certain qualifying events the right to temporary continuation of health coverage at group rates

question

HEDIS

answer

Health Plan Employer Data Information Set; NCQA too used by health plans to collect data about the quality of care and service they provide

question

Hill-Burton Act

answer

provided federal grants to modernize hospitals that had become obsolete due to lack of capital investment throughout the period of the Great Depression and World War II; in return for federal funds facilities agreed to provide free or reduced charge medical services to persons unable to pay

question

Hippocrates

answer

father of medicine; first physician to consider medicine a science and art separate from the practice of religion

question

NCQA

answer

National Committee for Quality Assurance

question

Hippocratic Oath

answer

adopted as an expression of early medical ethics and reflected high ideals

question

honorary

answer

retired medical staff member who is honored with emeritus status; also includes outstanding practitioners whom the medical staff wish to honor

question

hospital administration

answer

serves as liaison between the medical staff and governing board and is responsible for developing a strategic plan for supporting the mission and goals of the organization

question

hospital departments

answer

provide direct patient care as well as ancillary (eg, clinical laboratory) and support services (eg, health information department)

question

house officers

answer

physicians whose only job is to work at the facility treating patients; they are considered employees of the facility

question

Human Genome Project

answer

nationally coordinated effort to characterize all human genetic material by determining the complete sequence of the DNA in the human genome

question

hybrid record

answer

combination of paper reports and digital files

question

incomplete record processing

answer

includes the assembly and analysis of discharged patient records

question

intern

answer

historical term used to designate physicians in the first year of graduate medical education (GME); since 1975 the ACGME has referred to individuals in their first year of GME as residents

question

ICD-9-CM

answer

International Classification of Diseases, Ninth Revision, Clinical Modification; used in the US to collect information about diseases and injuries and to classify diagnoses and procedures

question

intranet

answer

private network that utilizes internet protocols and technology and allows users to immediate and simultaneously access health care information with complete security and an audit trail, regardless of where users are located

question

licensure

answer

obtaining a license to operate

question

living will

answer

contains the patient's instructions about the use of life-sustaining treatment

question

Medicaid (Title 19)

answer

joint federal and state program that helps with medical costs for some people and with low incomes and limited resources; programs vary from state to state, but most health care costs are covered for those who qualify

question

medical staff

answer

licensed physicians and other licensed providers as permitted by law (eg, nurse practitioners and medical assistants) who are granted clinical privileges

question

medical transcription

answer

accurate and time transcription of dictated reports (eg, history, physical examination, discharge summary)

question

Medicare (Title 18)

answer

health program for people 65 years of age and older, certain younger people with disabilities, and people with end-stage renal disease (ESRD)

question

MMA

answer

Medicare Prescription Drug, Improvement, and Modernization Act of 2003; provides Medicare recipients with prescription drug savings and additional health care plan choices; modernized Medicare by allowing private health plans to compete

question

Medieval medicine

answer

developed during the Middle Ages (or Dark Ages), most significant event was the construction of hospitals to care for the sick (eg, bubonic plague)

question

Middle Ages

answer

characterized by a lack of education except among nobility and the most wealthy; also called Dark Ages

question

minutes

answer

concise accurate records of action taken and decision made during a meeting

question

modern medicine

answer

characterized by the implementation of standards for sanitation, ventilation, hygiene, and nutrition; in addition, choosing health care as a profession became more acceptable, hospitals were reformed, and training of physicians and nurses improved

question

NPDB

answer

National Practitioner Data Bank; established by the federal Heath Care Quality Improvement Act of 1986; contains information about practitioner's credentials, including previous medical malpractice payment and adverse action history; state licensing boards, hospitals, and other health care facilities access this to identify and discipline practitioners who engage in unprofessional behavior

question

not-for-profit

answer

excess income is reinvested in the facility

question

ORYX initiative

answer

introduced by the Joint Commission to integrate outcomes and other performance measurement data into the accreditation process

question

paleopathology

answer

study of human remains

question

papyrus

answer

loose-textured porous white paper used as a writing material

question

Patient Safety and Quality Improvement Act of 2005

answer

amends Title IC of the Public Health Service Act to provide improved patient safety and reduced incidence of events adversely affecting patient safety

question

Patient Self-Determination Act

answer

requires consumes to be provided with consent, information about their right to make advance health care decisions (called advance directives), and information about state laws that impact legal choices in making health decisions

question

PQRI

answer

physician quality reporting initiative (PQRI); the Tax Relief and Health Care Act of 2006 authorized implementation to establish a financial incentive for eligible professionals who participate in a voluntary quality reporting program

question

prehistoric medicine and ancient medicine

answer

characterized by the belief that illness was caused by the supernatural; an attempt to explain changes in body functions that were not understood (eg, evil spirits were said to have invaded the body of the sick person)

question

primary care

answer

offers adult and family care medicine in internal medicine, pediatrics, and family practice

question

proprietary hospitals

answer

for-profit hospitals owned by corporations (eg, Humana), partnerships (eg, physicians), or private foundations (eg, Tarpon Springs Hospital Foundation)

question

public key cryptography

answer

attaches an alphanumeric number to a document that is unique to the document and to the person signing the document; uses an algorithm of two keys, one for creating the digital signature by transforming data into seemingly unintelligible form and the other to verify a digital signature and return the message to its original form

question

QIO

answer

quality improvement organization; new name for peer review organization; they continue to perform quality control and utilization of peer review of health care furnished to Medicare beneficiaries

question

quaternary care

answer

considered as an extension of "tertiary care" and includes advanced levels of medicine that are highly specialized, not widely used (eg, experimental medicine), and very costly; typically provided by tertiary care centers

question

record circulation

answer

includes retrieval of patient records for the purpose of inpatient readmission, scheduled and unscheduled outpatient clinic visits, authorized quality management studies, and education and research

question

regulation

answer

interpretation of a law; written by a responsible regulatory agency, such as Centers for Medicare & Medicaid Services

question

Renaissance medicine

answer

mostly associated with Europe; was characterized by a renewed interest in the arts, sciences, and philosophy; beginning of modern medicine, based on education instead of spiritual beliefs

question

resident

answer

physician who has completed an internship and is engaged in a program of training designed to increase his or her knowledge of the clinical disciplines of medicine, surgery or any other special fields that provide advanced training in preparation for the practice of a specialty

question

rules and regulations

answer

procedures based on federal and state regulations and accreditation standards, which clarify medical staff bylaws

question

secondary care

answer

services provided by medical specialists or hospital staff members to a patient whose primary care was provided by a general practitioner who first diagnosed or treated the patient (the primary care provider refers the patient to the specialist)

question

Shared Visions-New Pathways

answer

introduced by the Joint Commission in 2003 to radically change the survey process so it focuses on whether the organization is making improvements system-wide

question

smart card

answer

plastic card that contains a small central processing unit, some memory, and a small rectangular gold-colored contact area that interacts with a smart-card reader

question

standards

answer

measurements developed by an accreditation organization to evaluate a health care organization's level of performance in specific areas (usually more rigorous than regulations)

question

SCHIP

answer

State Children's Health Insurance Program; health insurance program for infants, children, and teens that covers health care services such as doctor visits, prescription medicines, and hospitalizations; see also Title XXI of the Balanced Budget Act of 1997

question

survey

answer

evaluation process conducted off-site and on-site to determine whether the facility complies with standards

question

TEFRA

answer

Tax Equity and Fiscal Responsibility Act or 1982; established the first Medicare prospective payment system, called Diagnosis-Related Groups (DRGs), which was implemented in 1983

question

DRG

answer

diagnosis-related groups; inpatient hospital cases classified into groups that are expected to consume similar hospital resources

question

teaching hospitals

answer

government (not-for-profit), proprietary (for-profit), or voluntary (non-profit) hospitals that are affiliated with a medical school

question

tertiary care

answer

services provided by specialized hospitals equipped with diagnostic and treatment facilities not generally available at hospitals or other primary teaching hospitals or Level I, II, II, or IV trauma centers

question

Title XXI of the Balanced Budget Act of 1997

answer

health insurance program for infants, children, and teens that covers health care services such as doctor visits, prescription medicines, and hospitalizations; see also SCHIP

question

triage

answer

an organized method of identifying and treating patients according to urgency of care required

question

universal chart order

answer

discharged patient record is organized in the same order as when the patient was on the nursing floor; eliminates the time-consuming assembly task performed by the health information department

question

veterans

answer

individuals who have served in the US military and who are eligible to receive care at VA Medical Centers

question

voluntary hospitals

answer

not-for-profit hospitals operated by religious or other voluntary groups (eg, Shriners)

question

cancer registrar

answer

collects cancer data from a variety of sources and reports cancer statistics to government and health care agencies (eg, state cancer registries); also called tumor registrar

question

utilization manager

answer

responsible for coordinating patient care to ensure the appropriate utilization of resources, delivery of health care services, and timely discharge or transfer; also called case manager

question

health insurance specialist

answer

reviews health-related claims to determine whether the costs are reasonable and medically necessary; based on the patient's diagnosis; also called claims examiner

question

coding and reimbursement specialist

answer

acquires a working knowledge of CPT and ICD-9-CM coding principles, government regulations, and third-party payer requirements to ensure that all diagnoses, services, and procedures documented in patient records are coded accurately for reimbursement, research, and statistical purposes; also called coding specialist

question

consultant

answer

one who practices a profession; a general term that can be applied to any number of individuals with a wide variety of educational backgrounds, knowledge, and skills

question

ethics

answer

judgments about what it right and wrong

question

health data analyst

answer

obtains employment in a variety of health care settings and is also employed by data warehousing companies to conduct research data management and clinical trials management

question

health information manager

answer

expert in managing patient health information and medical records, administering compute information systems, and coding diagnoses and procedures for health care services provided to patients

question

health services manager

answer

plans, directs, coordinates, and supervises the delivery of health care; includes specialists who direct clinical departments or services and generalists who manage an entire facility or system

question

listserv

answer

internet-based or email discussion forum that covers a variety of topics and issues

question

medical assistant

answer

performs routine administrative and clinical tasks to keep the offices and clinics of physicians, podiatrists, chiropractors, and optometrists running smoothly; not the same as physician assistants who examine, diagnose, and treat patients under the direct supervision of a physician

question

medical office manager

answer

coordinates the communication, contract, data, financial, human resource health information, insurance, marketing, and risk management operations of a provider's office; also called medical office administrator

question

medical staff coordinator

answer

responsible for managing the medical staff office functions and assisting with physician credentialing process

question

medical transcriptionist

answer

transcribes prerecorded dictation, creating medical reports, correspondence, and other administrative documents

question

privacy officer

answer

oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization's policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the health care organization's information privacy practices

question

professional practice experience supervisor

answer

individual to whom the student reports while completing the professional practice experience at a health care facility

question

quality manager

answer

coordinates a health care facility's quality improvement program to ensure quality patient care, improve patient outcomes, confirm accreditation and regulatory compliance, and prepare for surveys

question

reciprocity

answer

recognition of credentials by other entities

question

risk manager

answer

responsible for gathering information and recommending settlements concerning professional and general liability incidents, claims, and lawsuits

question

vendor salesperson

answer

manages a company's sales for a given territory, provides information about available consulting services, and demonstrates products to potential customers

question

1847

answer

American Medical Association (AMA) founded this year

question

1898

answer

Association of Hospital Superintendents/American Hospital Association (AHA) founded this year

question

1913

answer

American College of Surgeons (ACS) founded this year

question

1965

answer

Medicare and Medicaid programs enacted this year; JCAH hospitals granted deemed status for Medicare and Medicaid

question

1985

answer

Consolidated Omnibus Budget Reconstruction Act (COBRA) passed this year

question

1996

answer

Health Insurance Portability and Affordability Act (HIPAA) passed this year

question

1997

answer

State Children's Health Insurance Program (SCHIP) established this year

question

2001

answer

Centers for Medicare & Medicaid Services (CMS) created this year; replaced HCFA

question

2002

answer

Peer review organizations (PROs) will be known as Quality Improvement Organizations (QIOs) as of this year and will perform quality control; safeguard integrity of Medicaid trust fund

question

2003

answer

Medicare Prescription Drug, Improvement, and Modernization Act (MMA) implemented this year

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