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Chapter 1 - MEDISOFT -Medical Manager

Introduction to Health Information Technology and Medical Billing

AB
Health Information Technology (HIT)Technology that is used to record, store, and manage patient healthcare information
Practice Management Programs (PMPs)Software programs that automate many of the administrative and financial tasks in a medical practice
Electronic Health Record (EHR)A computerized lifelong healthcare record for an individual that incorporates data from all providers who treat the indivudual
DocumentationA record of healthcare encounters between the provider and the patient
Electonic Medical Records (EMRs)The computerized records of one physician's encounters with a patient over time
Personal Health Record (PHRs)Private, secure electronic files that are created, maintained, and owned by the patient
Electronic PrescribingThe use of computers and handheld devices to transmit prescriptions in digital format
Medical documentation and billing cycleA ten-step process that results in timely payment for medical services
Patient Information formA form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim
DiagnosisPhysician's opinion of the nature of the patient's illness or injury
ProcedureMedical treatment provided by a physician or other healthcare provider
CodingThe process of traslating a description of a diagnosis or procedure into a standardized code
Diagnosis codeA standardized value that represents a patient's illness, signs, and symptoms
ICD-9-CMAbbreviated title of International Classification of Diseases, Ninth Revi
ICD-10-CMAbbreviation title of International Classification of Dseases, Tenth Revision, clinical Modification, which will be used beginning on October 1, 2014
Procedure codea code that identifies a medical service
Current Procedural Terminology (CPT)The standardized classification system for reporting medical procedures and services
HCPCSCodes used for supplies, equipmant, and services not included in the CPT codes
Encounter formA lsit of the procedures and diagnoses for a patient's visit
ClearinghouseA company that receives claims from a provider, prepares them for processing, and trasmits them to the payers in the required format.
AdjudicationSeries of steps that determine whether a claim should be paid
Remittance advice (RA)A document that lists the amount that has been paid on each claim as well as the reasons for nonpayment or partial payment
Explanation of benefits (EOB)Paper document from a payer that shows how the amount of benefit was determined
Revenue cycle management (RCM)Managing the activities associated with a patient encounter to ensure that the provider receives full payment for services
Health Insurance Portability and Accountability Act of 1996 (HIPAA)Federal act that set forth guidelines for standardizing the electonic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information
Electronic data interchange (EDI)The exchange of routine business transactions from one computer to another using publicly available communications protocols
National Provider Identifier (NPI)A standard identifier for healthcar proviers consisting of ten numbers
HIPAA Privacy RuleRegulations for protecting individually identifiable information aboutoa patient's health and payment for healthcare that is created or received by a healthcare provider
Protected health information (PHI)Information about a patient's health or payment for healthcare that can be used to identify the person
HIPAA Security RuleRegulations outlining the minimun administrative, technical, and physical safeguards required to prevent unauthorized access to protected healthcare information
Audit TrailA report that traces who has accessed electronic information, when information was accessed, and whether any information was changed
Health Information Technology for Economic and Clinical Health (HITECH) ActPart of the American Recovery and Reinvestment Act of 2009 that provides financial incentives to phsicians and hospital to adopt EHRs and strengthens HIPAA privacy and security regulations
Meaningful useThe utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare sysstem
Regional Extension Center (RECs)Center that offer information, guidance, training, and support services to providers trasitioning to an EHR System
Health Information Exchange (HIE)A network that enables the sharing of health-related information among provider organizations according to nationally recognized standards
National Health Information Network (NHIN)A common platform for health information exchange across the country
Affordable Care Act (ACA)Federal legislation passed in 2010 that includes a number of provisions designed to increase access to healthcare, and explore new models of delivering and paying for healthcare
Accountable care organization(ACO)A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients
Patient-centered medical home (PCMH)A model of primary care tht provides comprehensive and timely car to paiens, while emphasizing teamwork and patient involvement



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