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