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MIC Bootcamp Alpha
Ms. Moneybags MIC Bootcamp Alpha Session
| Acronym or Term | Definition |
|---|---|
| MDS | Minimum Data Set |
| Minimum Data Set | used in long term facilities; assesses residents;required by Medicare and Medicaid |
| UHDDS | Uniform Hospital Discharge Datra Set |
| Uniform Hospital Discharge Data Set | data created to collect inpatient data by acute care hospitals |
| Tumor registry | every case entered is assigneda unique accession number preceeded by accession year |
| TNM tumor staging | system for staging malignant neoplastic disease |
| T in TNM | Tumor |
| N in TNM | Regional lymph node involvement |
| M in TNM | Metastases |
| CTR | Cancer Tumor Registry |
| COP | Conditions of participation |
| Conditions of Participation | published by CMS; set of regulations health care institutions must follow to receive Medicare reimbursement |
| Disease index | Lists in diagnostic order |
| Number control Index | ID's new health record numbers and patients assigned to those numbers |
| Physician index | ID's all patients treated by a physician |
| Master patient index | links each patient treated in a facility with the health number |
| Operation index | ID's operations performed |
| Procedure index | ID's procedures performed |
| Patient care plan | foundation of care for long term facilities |
| Charting by exception | method of charting only abnormal or unusual findings or deviations of standard of care |
| Hospital bylaws | general principals and policies of the medical staff |
| Federal Register | where CMS publishes Conditions of Participation (COP) for hospitals |
| SOAP | subjective;objective;assessment;physical |
| ROS | Review of systems |
| CC | chief complaint |
| Nomenclature | system of terms that is structured according to pre-established naming rules |
| Data Dictionary | Descriptive list of data elements to be collected in an information system or database |
| Patient self determination act of 1991 | requires advance directives not need to be placed in patients charts |
| HEDIS | Healthplan Employer Data and Information Set |
| Healthplan Employer Data and Information Set | measures outcome of care for managed care plan |
| OASIS | Outcome and Assessment Information Set |
| Outcome and Assessment Information Set | core items of an assessment for adult home care patient; measures patient outcomes |
| Interrator reliability | the extent to which two coders agree' addresses consistency |
| Data encryption | changes readable text into different set of characters and numbers |
| audit trail | program that records the action of a user |
| Firewall | system that prevents access to a private network from the outside or limits it |
| Utilization review | assessment of appropraiteness and economy of an admission. Length of stay is compared with other similar diagnoses. |
| Peer Review | evaluation of individuals professional performance by others in the profession |
| Continuity of Care | ensures that care stays consistent |
| CCI | Correct Coding Initiative; implemented in 1996 |
| 42 Code of federal Regulations part 2 | refers to regulations on confidentiality of alcohol and drug abuse patients records |
| Social Security Act of 1935 | established the social security program |
| Omnibus Budget Reconciliation Act of 1989 | created the Agency for Health Care Policy and Research |
| Health care Quality Improvement Act of 1986 | provided immunity to peer review entities and created national Practitioner Data Bank |
| ad hoc | means "for a special purpose" |
| POMR | Problem oriented medical record |
| granularity | relates to the fact that data can not be furhter subdivided |
| QIO | Quality Improvement Organization |
| SI/IS | severity of illness/ intensity of service |
| Auto authentication | allows dictated reports to be automatically considered signed unless the health management dept. is notified that revisions are needed |
| RVG's | Relative value guide |
| Relative Value Guide | reflects the difficulty and time spent by an anesthesiologist for a particular service |
| DRG | Diagnosis resource group |
| Diagnosis Resource Group | classify hospital cases into approximately 500 groups according to diagnoses |
| APC | Ambulatory Payment Classification group |
| HHRG | Home health resource Group |
| Home health resource group | source of payment for Home Health Agencies |
| RBRV's | Resource Based Relative Value |
Created by:
msmoneybags
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