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HEIM 360
Uses and Purposes of Health Records
Term | Definition |
---|---|
Master Patient Index (MPI) | Databases used in hospitals to retrieve patient demographics, insurance information against what a patient currently has to ensure accuracy of records |
Case Mix Index | Groups patients based on various variables such as procedures, diagnosis, or conditions for either the purpose of reimbursement or for hospitals use in staffing, equipment needs, etc. |
Quality Indicators | Standards of patient safety and quality improvement goals in hospitals that are compared on a state and national scale |
Utilization Management (UM) | Reviews that are conducted by hospitals, insurance companies, and other healthcare organizations to ensure patients receive quality care without wasting resources or money. |
Medical Necessity | Part of the utilization review that determines if a service is essential to the patients medical needs and quality of life. |
Diagnostic/Procedural Codes | Codes that are generated for medical conditions and procedures that are specifically designated for the purpose of billing and receiving payment |
Accreditation | Appointed by the Joint Commission (JC), this is an optional process where a hospital is evaluated on the standards expected by the JC and the overall quality of care provided to patients. |
Licensure | Is granted on the state level and defines the providers scope of practice in a certain region. It is mandatory in order to practice in any of the 50 states. |
Certification | Professional and educational requirements that determine an individual is qualified for a certain position based upon their credentialing. |
Informed Consent | Information requirements (purpose, procedures, risks, confidentiality) provided to a human subject prior to participating in clinical research study. |