computerized medical practice management ch.2
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Health Information Technology (HIT)
the computer hardware, software and networks that record, store, and manage patient health care information/
Information about the patient, as well as information about patient's medical insurance coverage.
Date of visit, location of treatment, diagnosis and procedure codes, charges, and the payments made at the time of an office visit
a company that receives claims from a provider, prepares them for processessing, and transmits them to the payers in HIPAA-compliant format.
a report from a clearinghouse that lists errors to be corrected before a claim can be submitted to the payer
A document listing charges and payments that is given to a patient after an office visit
An automated process for entering information from a remittance advice (RA) into a practice management program.
Electronic Medical Records (EMR's)
The computerized records of one physician's encounters with a patient over time.
Personal Health Records (PHR's)
Private, secure electronic files that are created, maintained, and owned by the patient.
Institute of Medicine has suggested that an EHR should have 8 core functions:
- 1. Health information and data elements.
- 2. Results management.
- 3. Order management.
- 4. Decision support.
- 5. Electronic communicastion and connectivity.
- 6. Patient support.
- 7. Administrative support.
- 8. Population reporting and management.
the use of computers and handhel devices to transmit prescriptions to pharmacies in digital format.
medical care based on the latest and most accurate clinical research
Health Information Technology for Economic and Clinical Health Act (HITECH)
Part of the American Recovery and Reinvestment Act of 2009 that provides financial incentives to physicians and hospitals to adopt EHRs and strengthens HIPAA privacy and security regulations.
a set of activities designed to produce a specific outcome
assigning preliminary diagnosis and procedure codes using computer software
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
federal act that set forth guidelines for standardizing the electronic data interchange of administrative and financial transactions, exposing fraud and abuse in government programs, and protecting the security and privacy of health information.
HIPAA Electronic transaction and code set standards
regulations regarding electronic transactions such as claim transmission to use standardized formats
Electronic Data Interchange (EDI)
- the exchange of routine business transactions from one computer to another using publicly available communications protocols.
- Ex. - sending email back and forth
ELectronic Funds Transfer (EFT)
The electronic routing of funds between banks
12-837 Health Care Claim (837P)
HIPAA standard format for electronic transmission of a professional claim from a provider to a health plan.
CMS- 1500 (08/05)
The mandated paper insurance claim form
National Provider Identifier (NPI)
A standard identifier for health care providers consisiting of ten numbers
HIPAA Privacy Rule
regulations for protecting individually identifiable information about a hapeint's health and payment for health care that is created or received by a health care provider
Protected Health Information
Information about a patient's health or payment for health care that can be used to identify the person.
HIPAA Security Rule
regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected healthcare information
Policies and procedures designed to protect electronic health information outlined by the HIPAA Security Rule
Mechanisms required to protet electronic systems, equipment, and data from threats, environmental hazards, and unauthorized intrusion
automated processes used to protect data and control access to data.
a report that traces who has accessed electronic information, when information was accessed, and whether any information was changed
the acquisition, access, use, or disclosure of unsecured personal health information in a manner not permitted under the HIPAA Privacy Rule.
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