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Procedures - correct answer Approved method for implementing an organization's formal position Policies - correct answer Written descriptions of the organizations formal positions Data - correct answer The dates, numbers, images, symbols, letters, and words that represent basic facts and observations about people, processes, measurements, and conditions. For example glucose level is 99. Information - correct answer Data that have been deliberately selected, processed, and organized to be useful. The interpretation of data Finance department - correct answer "Owner" of the Charge Description master (CDM) Chargemaster - correct answer A financial management form that contains information about the organization's charges for the healthcare services it provides to patients; Also called charge description master (CDM) Yes, but the committee may want to consider reducing this practice. HIPPA considers this to be "incidental disclosure". - correct answer Can a patient's full name be announced in the waiting room? Comorbitity - correct answer A medical condition that coexists with the primary cause for hospitalization and affects the patient's treatment and length of stay Complication - correct answer A medical condition that arises during an inpatient hospitalization (for example, a postoperative wound infection) MS-DRG - correct answer Medicare Severity Diagnosis-Related Groups CC - correct answer Complication or comorbidity MCC - correct answer Major complicating or comorbid condition Relative weight - correct answer Amount of resources it takes to treat a patient in a specific DRG Case Mix Index - correct answer Average of all the MSDRG relative weights for a hospital Indemnity Health Insurance - correct answer Traditional, fee-for-service healthcare plan in which the policyholder pays a monthly premium and a percentage of the usual, customary, and reasonable healthcare costs and the patient can select the provider Database that maintains reports on medical malpractice settlements, etc - correct answer National Practitioner Data Bank (NPDB) Occurrence report - correct answer A structured data collection tool that risk managers use to gather information about potentially compensable events; Also called incident report Continuing education - correct answer Training that enables employees to remain current with advancing knowledge in their profession...required for ALL coders Notice of privacy practices - correct answer Required on the FIRST provision of service Leapfrog Group - correct answer Organization that promotes healthcare safety by giving consumers the information they need to make better-informed choices about the hospitals they choose Medicare Part A - correct answer The portion of Medicare that provides benefits for inpatient hospital services; See hospitalization insurance Medicare Part B - correct answer An optional and supplemental portion of Medicare that provides benefits for physician services, medical services, and medical supplies not covered by Medicare Part A; See supplemental medical insurance Medicare Part C - correct answer A managed care option that includes services under Parts A, B, and D and additional services that are not typically covered by Medicare; Requires an additional premium; See Medicare Advantage Medicare Part D - correct answer Medicare drug benefit created by the Medicare Modernization Act of 2003 (MMA) that offers outpatient drug coverage to beneficiaries for an additional premium Medicare Part A benefit period - correct answer Begins on the day of admission and ends when the beneficiary has been out of the hospital for 60 days in a row, including the day of discharge. Expert system (ES) - correct answer A type of information system that supports the work of professionals engaged in the development or evaluation of complex activities that require high-level knowledge in a well-defined and usually limited area Benchmarking - correct answer The systematic comparison of the products, services, and outcomes of one organization with those of a similar organization; or the systematic comparison of one organization's outcomes with regional or national standards The hospital - correct answer Who owns hospital physical documents? Basic functions of the utilization management process - correct answer Discharge planning, retrospective review, and preadmission review Median number - correct answer Midpoint between the 2 middle observations Records information about patients treated for substance abuse and mental disorders. - correct answer Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision Systems development life cycle (SDLC) - correct answer A model used to represent the ongoing process of developing (or purchasing) information systems Cooperating Parties - correct answer ICD-9-CM coding guidelines established by? ORYX initiative - correct answer The Joint Commission's initiative that supports the integration of outcomes data and other performance measurement data into the accreditation process; Intrahospital mortality data - correct answer Data collection by Joint Commission for the ORYX initiatives? 60 days - correct answer How many days to get patient medical records in compliance with HIPPA regulations...records in offsite storage Medical necessity - correct answer 1. The likelihood that a proposed healthcare service will have a reasonable beneficial effect on the patient's physical condition and quality of life at a specific point in his or her illness or lifetime 2. Healthcare services and supplies that are proven or acknowledged to be effective in the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease, or its symptoms and to be consistent with the community's accepted standard of care. Under medical necessity, only those services, procedures, and patient care warranted by the patient's condition are provided 3. The concept that procedures are only eligible for reimbursement as a covered benefit when they are performed for a specific diagnosis or specified frequency; Also called need-to-know principle Screen layout - correct answer Critical element of data retrieval planning is designing a? Wide area network - correct answer Computer architectures best for implementing an EHR for a healthcare system that needs to transmit data to its various campuses that are located across a wide geographic area Run chart - correct answer A type of graph that shows data points collected over time and identifies emerging trends or patterns. One of the most important tools for assessing the effectiveness of change. They help improvement teams formulate aims by depicting how well (or poorly) a process is performing. CPT lacerations - correct answer One CPT code, adding the lengths of the lacerations together CPT/HCPCS - correct answer The APC payment system is based on what coding program? Ambulatory payment classification group (APC group) - correct answer Basic unit of the ambulatory payment classification (APC) system. Within a group, the diagnoses and procedures are similar in terms of resources used, complexity of illness, and conditions represented. A single payment is made for the outpatient services provided. Based on HCPCS/CPT codes. Conditions of Participation - correct answer The administrative and operational guidelines and regulations under which facilities are allowed to take part in the Medicare and Medicaid programs; published by the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services; Also called Conditions for Coverage Accusations of fraud and abuse - correct answer Goal of coding compliance programs is to prevent? True - correct answer True or false? Institutions are allowed flexibility in the way they implement HIPAA standards Physician champion - correct answer An individual who assists in communicating and educating medical staff in areas such as documentation procedures for accurate billing and appropriate EHR processes Unit numbering system - correct answer A health record identification system in which the patient receives a unique medical record number at the time of the first encounter that is used for all subsequent encounters Unit - correct answer Which of the numbering systems is best for maintaining the encounters of a patient together? Outpatient code editor (OCE) - correct answer A software program linked to the Correct Coding Initiative that applies a set of logical rules to determine whether various combinations of codes are correct and appropriately represent the services provided; See editor Inpatient service day (IPSD) - correct answer A unit of measure equivalent to the services received by one inpatient during one 24-hour period Database management system - correct answer Best tool for tracking coder productivity Database management system (DBMS) - correct answer Computer software that enables the user to create, modify, delete, and view the data in a database Premium - correct answer Amount of money that a policyholder or certificate holder must periodically pay an insurer in return for healthcare coverage Legal health record (LHR) - correct answer Documents and data elements that a healthcare provider may include in response to legally permissible requests for patient information Integrated health record format - correct answer A system of health record organization in which all the paper forms are arranged in strict chronological order and mixed with forms created by different departments Best of breed - correct answer A vendor strategy used when purchasing an EHR that refers to system applications that are considered the best in their class - different vendors Best of fit - correct answer A vendor strategy used when purchasing an EHR in which all the systems required by the healthcare facility are available from one vendor Major medical insurance - correct answer Prepaid healthcare benefits that include a high limit for most types of medical expenses and usually require a large deductible and sometimes place limits on coverage and charges (for example, room and board); Also c