CAHIMS Class 2023 with verified questions and answers

Three Types of Healthcare Primary, Secondary, and Tertiary Five Non-Hospital Inpatient Facilities Post-Acute Inpatient Care, Skilled Nursing Facilities (SNFs or "Sniffs"), Long-Term Acute Care Hospitals, Long-Term Adult Care, and Hospice Care Seven Outpatient Healthcare Service Centers Physician Office, ASC, ED, Diagnostic Services, Community Health Clinics, School-Based Health Centers, and Employer Based Clinic Seven places where care is provided Inpatient Hospitals, Inpatient Non-Hospital Facilities, Outpatient Facilities, Home Healthcare, Federal Healthcare Facilities, and Networks both Horizontal and Vertical Five executives in management patient care and information CIO, CMO, CNO, CMIO, and CNIO Three managed care plans HMO, PPO, and POS Types of Medicare A - Hospital Insurance and Skilled Nursing, B - Medical Insurance Clinic and Outpatient, C - Medicare Advantage put A/B and sometimes D together, D - Drug Coverage Eight parts of medical billing process Scheduling, Registration, Delivery of Medical Services, Charge Capture, Coding, EOB, Reimbursement, Final and Settlement What ICD CM and CPT stand for International Classification of Disease Clinical Modification and Current Procedural Terminology DRG or Diagnosis Related Group How Medicare and some insurance classify hospital cases into 467 groups of "products" provided and determine how much to pay ERISA or Employee Retirement Income Security Act Act in 1974 set minimum standards in pensions and health plans COBRA Act providing health benefit provisions in 1986 which amended ERISA to provide continuation of group health coverage that would otherwise be terminated HIPAA or Health Insurance Portability and Accountability Act Act in 1996 which protects health insurance coverage on loss of job and established standards for electronic health care transactions Patient Protection and Affordable Care Act Act in 2010 overhauled hospital and primary physician practices to drive better outcomes and lower costs. It also was intended to increase health insurance accessibility, quality, and affordability HITECH or Health Information Technology for Economic and Clinical Health Act Act was part of ARRA in 2009 and promotes the adoption of health information technology, such as a nationwide network of electronic health records, which is considered needed to do population health management Meaningful use Includes use of a certified EHR in a meaningful manner such as e-prescribing, electronic exchange of health information to improve quality, and submitting clinical quality measures Joint Commission Accredits and certifies nearly 21,000 health care organizations and programs in the US Joint Commission International Organization that works to improve patient safety and quality of health care in the world community by offering education, publications, advisory services, and world-wide accreditation and certification URAC or Utilization Review Accreditation Commission Nonprofit that helps promote health care quality through accreditation of organizations involved in medical care services as well as education and measurement Certification and Licensure Two ways that health professionals are regulated Software Development Life Cycle Planning/Exploration, Requirements, Design, Coding, Testing, and Deployment/Maintenance MUMPS or M Multipurpose programming language with built-in hierarchical database EMR Electronic record system of incidental medical event which is used to generate billing EHR Provides the longitudinal record of a patient and may be generated by multiple encounters in a care delivery setting Example information contained in an EHR Demographic, laboratory, problems, progress notes, radiology reports, images, and immunizations Provision of knowledge and decision support Provided by EHR which facilitates quality, safety, and efficiency of patient care Four example functions of an EHR CPOE for prescriptions, electronic orders for tests, results of tests, physician notes EHR features E-Prescribing, Expert Systems/Clinical Decision Support Systems (CDSS), and using CPOE to prevent common medication errors RHIO or Regional Health Information Organization Network of stakeholders within a defined region who are committed to improving the quality, safety, access, and efficiency of healthcare through the use of HIT PMS or Practice Management System Software that deals with day-to-day management of a practice including the capture of patient demographics, appointment scheduling, maintaining list of insurance payors, billing, and reports Six Sigma A business management strategy, that seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes