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Billing & Coding Ch2
| Question | Answer |
|---|---|
| HMO | Health Maintenance Organization |
| Medical standards of care | state-specified performance measures for healthcare delivery |
| Evaluation and Management (E/M) | provider’s evaluation of a patient’s condition and decision on a course of treatment |
| Health Information Technology for Economic and Clinical Health (HITECH) Act | a law with provisions concerning standards for electronic transmission of healthcare data |
| Health information exchange (HIE) | makes it possible to share health-related information among provider organizations. |
| accountable care organizations (ACOs) | a network of doctors and hospitals who share responsibility for managing quality and cost of care provided to a group of patients |
| Affordable Care Act (ACA) | Health system reform legislation that offers improved insurance coverage and other benefits |
| Covered Entity (CE) | Healthcare organization (health plan, clearinghouse, provider, or business associate) that transmits HIPAA- protected information electronically. |
| Clearinghouse | Company that converts nonstandard transactions into standard transactions and transmits the data to health plans (and the reverse procedure) |
| Electronic data interchange (EDI) | computer-to- computer exchange of data in a standardized format |
| Protected health information (PHI) | individually identifiable health information transmitted or maintained by electronic media |
| Designated record set (DRS) | CE’s records that contain PHI |
| Accounting for disclosure | documentation of the disclosure of a patient’s PHI in that person’s medical record in unauthorized cases. 2-21 |
| National Provider Identifier (NPI) | unique ten-digit identifier assigned to each provider |
| Omnibus Rule | set of regulations enhancing patients’ privacy protections and rights to information, and the government’s ability to enforce HIPAA |
| Compliance plan | medical practice’s written plan for complying with regulations |
| Guarantor | The individual that is responsible for paying any patient responsibility after the insurance has processed the claim |
| PPO | a type of managed care organization where providers join the network and are considered preferred when patients seek treatment |
| Capitation | an agreement with a provider to receive a pre-established payment for health care services to enrollees over a period of time |
| Deductible | the annual amount the patient must pay before the insurance will begin to pay for covered benefits |
| COB | coordination of benefits |
Created by:
shawnettadj
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