The Health Information Management Department
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Abstracting | Collection of data from the medical record for statistical and planning purposes.
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| Analysis | Reviewing the medical record to determine that all required documentation is present including signatures and reports.
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| Cancer registry | A database of patients diagnose with cancer.
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| Coding | Assignment of numbers to diagnoses and/or procedures using the current edition of a coding or classification system such as the International Classification of Diseases (ICD) or Current Procedural Terminology (CPT).
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| Deficiency slip | A document that identifies deficiencies in documentation.
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| Healthcare provider | An individual or facility, such as a hospital, that provides healthcare to a patient.
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| JCAHO | Joint Commission on the Accreditation of Healthcare Organizations.
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| Ligitation | Lawsuit.
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| Medical record number | A unique number assigned to a medical record in order to identify it.
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| Medical transcription | Interpretation and typing of reports dictated by physicians and other healthcare personnel.
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| Medicare | Federal insurance for patients over 65 or for the disabled.
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| Performance improvement | Evaluating the overall performance of a healthcare facility, from the environment to the patient care, with the purpose of continuous improvement.
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| Periodical | A magazine or journal published at specified periods, for example, weekly or monthly.
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| Physician incomplete area | Area of the health information management department where physician regarding the patient's progress during hospitalization or other treatment.
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| Physician progress note | Handwritten or typed entries made by the physician regarding the patient's progress during hospitalization or other treatment.
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| Risk management | Addressing the risk to which patients, visitors, hospital staff, medical staff, vendors, and others are exposed.
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| Third party | A person or entity, such as an insurance company, other than the healthcare facility or patient.
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Created by:
yunue03
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