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Chapter 1 CIMO

One way to lower the cost of healthcare is
to increase the use of technology
What term refers to the computer hardware, software, and networks that are used to record, store, and manage patient healthcare information?
health information technology (HIT)
A practice management program (PMP) is a software program that
-records patients’ payments and prints receipts
-processes the financial transactions that result from patients’ appointments
-calculates charges for office visits
Which task is NOT performed by a practice management program?
assigning diagnosis codes
What does a PMP require to create and transmit healthcare claims?
collection of information from various databases and create a claim file
What method of filing a claim has replaced paper claim forms?
electronic transmission
Which of these are computerized records of one physician’s encounters with a patient over time?
electronic medical records (EMRs)
According to the Institute of Medicine, which of the following core functions should be included in an EHR?
-decision support
-order management
-population reporting and management
Which records offer a broad focus on a patient’s total health experience over the lifespan, rather than the documentation of episodes of illness or injury?
electronic health records (EHRs)
What is NOT a common element of reporting and population management within EHRs?
patient’s identity
What term refers to medical care that uses the latest and most accurate clinical research in making decisions about the care of patients?
evidence-based medicine
Reminding patients about preventive care screenings is an example of which advantage of EHRs?
quality
The ten-step cycle that results in the timely payment for patients’ medical services is the
medical documentation and billing cycle
Which of the following information should be collected from new patients during preregistration?
-the patient’s name
-the patient’s contact information
-the patient’s reason for the visit
What must be in place in a medical office to provide medical care to patients and collect payment for these services?
work flow
A steady flow of income into a practice is known as what?
revenue
What expenses is not necessarily paid on a regular, recurring basis?
legal services
Which information is contained in office visit documentation?
the diagnosis and procedures
Which of the following refers to diagnosis codes?
ICD
Which of the following refers to procedure codes?
CPT
An encounter form is also known as a
superbill
The provider’s fees for services are listed on the medical practice’s
fee schedule
What is a series of steps designed to determine whether a claim should be paid?
adjudication
The remittance advice provides details about each patient transaction, including
-the date of service
-the services provided
-the patient identification number
When a medical practice receives an overpayment from a health plan, it
issues a refund
What document lists all services performed, along with the charges for each service?
statement
A company that receives electronic claims and forwards the claim to the payer is known as
a clearinghouse
Revenue cycle management refers to
managing the activities associated with a patient encounter to ensure the provider is paid
Which of the following are rules created under HIPAA?
-HIPAA Privacy Rule
-HIPAA Electronic Transaction and Code Sets standards
-Final Enforcement Rule
What describes a particular electronic format that providers and health plans must use to send and receive healthcare transactions?
HIPAA Electronic Transaction and Code Sets
Electronic data interchange involves sending information from computer to
computer
In most physician practices, the claim format is the HIPAA-standard
X12-837 Health Care Claim
Health information that can be used to find out a person’s identification is referred to as
protected health information
Which term refers to the acquisition, access, use, or disclosure of unsecured PHI in a manner not permitted under the HIPAA Privacy Rule, thus compromising the security or privacy of the PHI?
breach
Recognizing that existing HIPAA laws did not provide adequate protection in an increasingly electronic healthcare environment, Congress included additional privacy and security regulations in the
HITECH Act of 2009
What government regulation is intended to promote the use of EHRs in physician practices and hospitals through the use of financial incentives?
the HITECH Act
Under HITECH, which government body is required to conduct audits to ensure compliance with HIPAA rules?
Office of Civil Rights (OCR)
The utilization of certified EHR technology to improve quality, efficiency, and patient safety in the healthcare system is known as what?
meaningful use
A network of doctors and hospitals that shares responsibility for managing the quality and cost of care provided to a group of patients is known as
an accountable care organization
What is health information technology?
record, store,and manage patient healthcare information
Practice management programs (PMP)
software that automate many administrative and financial tasks in the medical practice
Medical documentation and billing cycle
a ten step process that results in timely payment for medical services
Diagnosis
physicians opinion of the nature of the patients illness or injury
Procedure
medical treatment provided by a physician or other healthcare provider
ICD-9-CM
International Classification of Disease, Ninth Revision, Clinical Modification. The source of codes used for reporting diagnosis until October 1, 2014
ICD-10-CM
International Classification of Disease, Tenth Revision, Clinical Modification, which will be used beginning on October 1, 2014
Current Procedural Terminology (CPT)
standardized classification system for reporting medical procedures and services
HCPCS
codes used for supplies, equipment, and services not included in CPT codes
encounter forms
a list of procedures and diagnoses for a patients visit
Explanation of Benefits (EOB)
paper document from a payer that shows how the amount of a benefit was determined
Revenue cycle management (RCM)
ensure full payment

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