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HEIM 360

Uses and Purposes of Health Records

TermDefinition
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.
Created by: nharding818