Account Number
unique number given for every episode of care for billing purposes
Medical Record Number
unique number given to individual that they use every time they go to facility
Hippocrates
father of modern medicine
rational non religious approach
started auscultation, performed surgical operations, and kept daily records
"hippocratic oath" stating the obligations and proper conduct of doctors, formerly taken by those beginning medical pract
Florence Nightingale
mother of modern cleanliness
brought order and cleanliness to healthcare
"first true healthcare administrator"
was a nurse in the Crimean War
For profit and non for profit
Not for profit- extra money made either goes back to hospital or to charitable source, no taxes
for profit (proprietary)- extra money goes to investors of the company
Det Norske
The Joint Commission
American Osteopathy Association
the 3 governing bodies who survey hospitals for accreditation
C-Sweet
CFO- money/budget
CEO- implements policies/direction/hires best staff, Responsible for implementing the policies and strategic direction set by Board of Directors
CIO- information-EHR makes harder because not standardized.
CNA
COO- in training for CEO, av
fiduciary
putting your needs/thoughts aside and acting in the best interest of the hospital
"fiduciary responsibility
sentinel event
a very bad event that happens in a hospital that must be reported to the CMS or accrediting body
ex) suicide in hospitals, amputation the wrong leg
hospitium
before hospitals it was a safe place to pilgrims to go when they were traveling where they could receive housing, food, and medical attention
after this arouse the idea of hospitals and the Catholic church said there must be a hospital in all major cities
to be a hospital you must have
facility
medical staff
beds
diagnostic and therapeutic services
nursing staff 24 hours
triage
sorting done in medical emergency situations to see who needs to be treated first
Trauma levels
1- gunshot wound
2
3
4-sprain ankle
informatics
using electronics to USE data to help make decisions
the field of information science concerned with the management of all aspects of health data and information through the application of computers and computer technologies
HIM
integrity of the record and patient
US healthcare system compared to other countries
ranked 37th
17.5 of GOD used on healthcare
WHO- World Health Organization
meaningful use
the implementation of EHR and using them in a meaningful way will receive incentives
doesn't include long term care or behavioral health facilities
Described in the Act as:
Use of "EHR technology in a meaningful manner" (which for physician incentives sha
CPT- how physicians get paid
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CPC
certified professional coder
american association of professional coders gives the accreditation
Certified Professional Coder (CPC) is the first line of defense against noncompliance and down-coding for any medical provider. Certified coders help prevent
CCA
certified coding assistant
AHIMA accredited
CCS
certified coding specialist
CCS-P
certified coding specialist- physician based
iron quality of care
access- available to all people
cost-Delivered with reasonable quality
quality-Comprehensive but stress maximum economic efficiency
Licensure
Licensure - gives legal approval for a facility to operate or for an individual to practice within their profession
Issued by state agency - health department
Mandatory - except for federal facilities
Reviewed annually
Texas - licensure granted by the Tex
Accreditation
voluntary
cost money and is a lot of work that's why some facilities are not accredited
high standard
Join commision, DNV, American osteopathic Association
Voluntary process of periodic institutional review by an independent body that evaluates the qualit
The Joint Commission
An independent accrediting body for hospitals and other healthcare organizations
American Osteopathic Association
An independent accrediting body for osteopathic hospitals and other healthcare organizations
Del Norske Veritas Healthcare, Inc.
A global provider of services for managing risk, helping customers to safely and responsibly improve their business performance.
Accreditation Process look at PP
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Biologics Control Act
first federal law affecting healthcare
To regulate interstate sales of vaccines and serum
Early research on methods to control epidemics of infectious diseases
Social Security Act
first federal payment for indigent healthcare (precursor to Medicaid)
Social insurance program - did not include health insurance
Matched state funds for maternal and infant care, rehabilitation of crippled children, general public health work, aid for de
Hill Burton
to build hospitals after the World War
Grants for states to construct new hospitals and modernize old ones
1946 - 3.2 beds per 1,000 persons - goal was 4.5 beds per 1,000 persons
2009 3.1 beds per 1,000
2016 2.8 beds per 1,000
Medicare and Medicaid
Medicare
Nation's largest insurance plan
Covers more than 55 million individuals
Provides healthcare for those 65 or older who are covered by Social Security; certain disabled individuals; and individuals who have end stage renal disease
Signed by Preside
TEFRA
Tax Equity and Fiscal Responsibility Act 1982
Purpose - to control rising costs to provide fee based healthcare to Medicare beneficiaries
Required gradual implementation of prospective payment system (PPS) for Medicare reimbursement
Retrospective payment
EMTALA -
Emergency Medical Treatment and Active Labor Act -1986
To ensure public access to emergency services regardless of ability to pay
Hospitals that offer emergency services must provide a medical screening examination (MSE) when a patient presents to the eme
HIPPA
Health Insurance Portability and Accountability Act 1996
Created Healthcare Integrity and Protection Data Bank (HIPDB)
To address issues related to portability of health insurance after leaving employment
To address privacy and security of protected healt
(ARRA) - HITECH
2009 American Recovery and Reinvestment Act
The American Recovery and Reinvestment Act (ARRA) - Public Law 111-5
Signed by President Obama 2/17/09
ARRA provides many stimulus opportunities, including $19.2 billion for health IT
Title XIII of ARRA is the H
(ACA)
2010 Patient Protection and Affordable Care Act
The most sweeping legislation since Medicare and Medicaid were signed into law by LBJ in 1965
End to denial of insurance coverage for pre-existing conditions
Small business tax credits - up to 50% of premium
RHIA
Registered Health Information Administrator (2000)
Previously -
RRL - Registered Record Librarian (1933)
RRA - Registered Record Administrator (1978)
RHIT
Registered Health Information Technician (2000)
Previously -
ART - Accredited Records Technician (1953)
FAHIMA
Fellow of the American Health Information Management Association (1999)
highest ranking AHIMA
must have advanced degree and con. education
CDIP
Clinical Documentation Improvement Practitioner (2011)
CHDA
Certified Health Data Analyst (2009)
CHTS
Certified Health Technology Specialist (2014)
CMS
Centers for Medicare & Medicaid Services
continuing education
Continuing Education provides evidence to the public that individuals in a profession maintain competence following certification
Maintaining competence in the health related fields is especially critical because of the rapid changes in technology, change
Deemed status
Hospitals participating in Medicare must meet certain specified requirements
The requirements -The Conditions of Participation - are documented in the Federal Register
Conditions of Participation available electronically
Hospitals may be surveyed by Medic
Governing Body/Board of Directors
Responsible for setting overall direction of the hospital
peer review
Clinical Peer Review is the best term to collectively refer to all such activity. Medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met accepted standard
National Practitioner Data Bank
United States Government program that the collects and discloses, only to authorized users, negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid.
Prospective Payment System
is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inp
Professional definition of HIM
HIM improves the quality of healthcare by ensuring that the best information is available to make any healthcare decision
HIM professionals manage healthcare data and information resources
The profession encompasses services in planning, collecting, aggre
Profession - list and describe the six characteristics
Identifies core values on which the HIM mission is based
Summarizes broad ethical principles that reflect the profession's core values
Helps HIM professionals identify relevant considerations when conflict or ethical uncertainties arise
Provides principle
Conditions of Participation
Search Results
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule in the October 24 Federal Register that revises the requirements - commonly referred to as Conditions of Participation (CoPs) - that hospitals and critical access h
Nurse Practitioner (NP)
Registered nurse with advanced education
Collaborate with physicians; but may be more independent that PAs
Treat and diagnose
Teach wellness and prevention
Physical exams, x-rays, EKGs, lab tests
Prescribe medications
Refer for rehabilitation
Physician Assistant (PA)
Created in 1960s to help fill a shortage of primary care physicians
PAs must work under the supervision of a physician
Follow a medical model of training
Conducts physical exams
Diagnoses and treats
Orders and interprets tests
Prescribes medicines
Certified Registered Nurse Anesthetist (CRNA)
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Nurse Midwife
Registered Nurses who have undergone an accredited midwifery program and after certification, become a certified nurse-midwife (CNM)
Provide prenatal care to expectant mothers
Care for infant during birth
Assist mother and infant postpartum
Medicare Severity DRG (MS-DRG)
A Medicare Severity-Diagnosis Related Group (MS-DRG) is a system of classifying a Medicare patient's hospital stay into various groups in order to facilitate payment of services.
level 1
Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury - from prevention through rehabilitation.
level2
Level II Trauma Center is able to initiate definitive care for all injured patients.
level3
A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.
level4
A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients.
level5
A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.
clinical data
all of the medical data that have been recorded about the patients stay or visit including diagnosis and procedures
demographic data
name, address, age, gender identify the patient
Epidemiologic data
the study of morbidity ( disease) trends and occurrences- epidemiology
classification of hospitals
Community or specialty
Governmental or non-governmental
For profit or not for profit
Bed size 1-74 beds; 75-99 beds; 100-149 beds, etc.
Critical Access hospitals -25 beds or less
Rural vs. Urban
(Teaching vs. non-teaching)
American College of Surgeons
educational association
the College provides membership for doctors worldwide specializing in surgery who pass a set of rigorous qualifications
American Health Information Management Association (AHIMA)
The American Health Information Management Association is a professional association for health professionals involved in the health information management needed to deliver quality health care to the public
American Osteopathic Association
The American Osteopathic Association (AOA) is the representative member organization for the more than 129,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States.
Centers for Medicare & Medicaid Services (CMS)
is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid
Credentialing and privileging
credentialing- screening process that the medical staff uses to evaluate a physician's application for membership
every 2 years of when change of specialty
"privileging," which is the process of authorizing a licensed or certified healthcare practitioner'
Det Norske Veritas
free-standing, autonomous and independent foundation whose purpose is to safeguard life, property and the environment.
approved by the CMS to deem hospitals in compliance with the CMS Conditions of Participation for hospitals
The Joint Commission
The Joint Commission is a United States-based nonprofit tax-exempt 501 organization that accredits more than 21,000 US health care organizations and programs
Tripartite relationship between CEO, Board and Medical Staff
Governing Body/Board of Directors
Responsible for setting overall direction of the hospital
CEO (Management)
Responsible for implementing the policies and strategic direction set by Board of Directors
Medical Staff
Responsible for providing care to patien
to be considered for liscnesure must meet minimum of
offer services, facilities, beds, <24 hrs for 2 more unrelated individuals requiring diagnosis, treatment or care for illness, injury, deformity, abnormality or pregnancy;
and regularly maintain, at a minimum, clinical laboratory services, diagnostic x-ra