RHIT prep
Fraud
Intentional deception/misrepresentation made knowingly that is false to get unauthorized payment
Common law
Judicial law or case law (decisions)
Constitutional law
Law that deals with amount and types of power governments are given (Constitution - executive, legislative and judicial branches)
Administrative law
Law that executive branch enforces laws enacted by legislative body (Code of Federal Regulation & is under the umbrella of public law)
Statutes (statutory) law
Law that is enacted by legislative body (Medicare & HIPAA)
Stare Decisis
Let the decision stand
Respondeat Superior
Let the master answer
CDR (clinical data repository)
a data base that manages data from different source systems in the hospital or other provider settings and supports management of data for an EHR
Data dictionary
a list of data elements that ensures consistency in a database
Knowledge management system
a more recent type of information system that has the potential to increase workflow
Malfeasance
a wrong or improper act (to cause intentional harm)
Source-oriented health record
all forms in the record are in chronological order
data Comprehensiveness
all required data elements are included in the health record
Edit checks
assist in ensuring data integrity
Histogram
bar graph displays data proportionally (continuous data and frequency)
Pareto chart
bar graph used to determine priorities and problem solving (cumulative)
Fishbone
cause and effect diagram (4 P's people, procedure, policies and plant)
Pie chart
chart shows relationship of each part to the whole
Gantt chart
chart that shows duration and overlapping of tasks
Flow chart
chart to help all team members understand the process in the same way
Force field
chart used to display data generated through brainstorming
Scatter diagram
chart used to plot the points for 2 continuous variables that may be related to each other in some way
data Consistency
data are reliable
data Timeliness
data being recorded at or near the event or observation time frame in which the health records are coded
data Relevancy
data in the health record are useful
data Accessibility
data is easily obtainable
data Currency
data should be up to date
LOINC
database protocol that standardizes lab and clinical codes for use in clinical care, outcomes management and research
IRB (Institutional Review Board)
deals with ethical treatment of human research subjects
data Precision
describes expected data values
Beneficence
do good for others
Nonmaleficence
do not harm others
Medical necessity
every procedure code must be linked to a diagnosis code that justifies its need to be performed
Nonfeasance
failure to act (such as failure to order diagnostic tests)
Bar graph
graph used to display discrete categories data (gender, race, ethnicity, health insurance, etc)
Prevalence
how common a disease is in a population
Occurance
how often a disease occurs in a population
Misfeasance
improper performance during an otherwise correct act (such as nicking something during surgery o remove something else)
System
integrates several elements of a business process to achieve a goal
Care management
non-clinical review of the care of the patient to identify patterns and trends
Case management
performed by clinical professionals for the review of clinical care to ensure medical necessity
Line chart
plotted chart that shows progress of a process over time
Incidence
probability of risk of an illness in a population over a period of time
Writ of certiorari
request/petition to Supreme Court to hear a case
data Granularity
requires that the attributes and values of data be defined at the correct level of detail for the intended use of data
Autonomy
self determination
Control chart
sideways bell chart focuses attention on any variation (+ or - 1 or 2)
Data warehouse
special type of database that consolidates and stores data from various databases
HL7
standards that aid the exchange of data among hospital systems, physicians practices and other types of provider systems
Certification
the act granting approval for a healthcare organization to provide services to a specific group of beneficiaries (shows a facility has reached a higher level of care, grantor such as CMS)
Licensure
the act of granting a healthcare organization or an individual healthcare provider permission to provide services of a defined scope in a limited geographical area (grantor such as the state)
Accreditation
the act of granting approval to a healthcare organization (grantor such as JC)
Validity
the degree to which codes accurately reflect the patients diagnoses and procedures
Completeness
the degree to which codes capture all the diagnoses and procedures in the health record
Reliability
the degree to which the same results are achieved consistently
Utilization management is
the process of determining whether the medical care provided to a specific patient is necessary according to pre-established objective screening critera
Qui tam
the whistle blower provision of the false claims act
Justice
treat others fairly
Elements of negligence
1. Duty to meet standard of care (nonfeasance) 2. Breach of duty - deviation from the duty (malfeasance) 3. Causation - which is a relationship between the defendants conduct and the harm that was suffered (misfeasance) 4. Injury or harm - may be economic and/or non-economic (pain and suffering)
The Revenue cycle components
1. Preclaims submission activities 2. Claims processing activities 3. Accounts receivable 4. Claims reconciliation and collections
Abuse
Actions inconsistent with accepted sound medical, business or fiscal practices
ADT
Admission, Discharge, Transfer
ABC
Advanced billing concept
Confidentiality
The expectation that the information will only be used for its intended purposes (only shared as needed)/minimum necessary)
Security
The physical and electronic protection of the integrity, availability and confidentiality of EHR
Privacy
The right to be let alone, the right of individuals to control access to their own PHI
Res ipsa loquitur
The thing speaks for itself (it is what it is)
Functions of Utilization Management are
• prospective utilization review - pre-admission review • concurrent utilization review - continued stay review and discharge utilization review • retrospective utilization review - conducted after the patient has been discharged It ensures medical necessity of treatment provided and costs effective use of resources