CH. 1 HIM Terms

Health Information Management: Concepts, Principles, and Practice 5th edition

Accountable care organization (ACO)

A group of service providers that work together to manage and coordinate care to Medicare fee-for-service beneficiaries. Guidelines for the establishment of an ACO are under the purview of the secretary of HHS, but they may include quality reporting, e-prescribing, and the use of electronic health records.

Accreditation

Provider organizations seek this to prove that they meet the standards of legitimate and appropriate medical practice

Acute care

The short-term care provided to diagnose and treat an illness or injury.

Allied health professional

Work with physicians and nurses and have received specialized training.

Ambulatory care

Is the provision of preventative or corrective healthcare services on the nonresident basis in a provider’s office, clinic setting, or hospital outpatient setting.

Biotechnology

The field devoted to applying the techniques of biochemistry, cellular biology, biophysics, and molecular biology to address practical issues related to human beings, agriculture, and the environment.

Centers for Medicare and Medicaid Services (CMS)

maintains oversight of the survey and certification of nursing homes and continuing care providers (including hospitals, nursing homes, home health agencies, end-stage renal disease facilities, hospices, and other facilities serving Medicare and Medicaid beneficiaries) and makes information about these activities available to beneficiaries, providers and suppliers, researchers, and state surveyors.

Certification

The process by which government and nongovernment organizations evaluate educational programs, healthcare facilities, and individuals as having met predetermined standards.

Chief executive officer (CEO)

Is responsible for implementing the policies and strategic direction set by the hospital’s board of directors

Clinical privileges

The medical staff is the aggregate of physicians who have been granted permission to provide clinical services in the hospital.

Continuum of care

Patients are provided care by different caregivers at several different levels of the healthcare system. primary provider to home care to snf.

Deemed status

In order for healthcare organizations to participate in and receive payment from the Medicare and Medicaid programs, [they] must be certified as complying with the conditions of participation, or standards, set forth in federal regulations.

For-profit

This healthcare organization is privately owned. Excess funds are paid back to the managers, owners, and investors in the form of bonuses and dividends

Health maintenance organization (HMO)

Usually, only pay for care within their own network, and the primary care doctor coordinates care

Health savings account (HSA)

AKA Medical savings accounts, offer participants the opportunity to control how their healthcare dollars are spent.

Home healthcare

Is a wide range of healthcare services that can be delivered in the home, and it is the fastest-growing sector to offer services for Medicare recipents.

Hospice care

is provided mainly in the home to the terminally ill and their families.

Hospital

Can be applied to any healthcare facility that has the following four characteristics:

• An organized medical staff

• Permanent inpatient beds

• Around-the-clock nursing services

• Diagnostic and therapeutic services

Hospital outpatient

A patient who receives hospital services without being admitted for inpatient (overnight) clinical care.

Inpatient

A person who is provided with room, board, and continuous general nursing services in an area of an acute-care facility where patients generally stay at least overnight.

Integrated delivery system (IDS)

Combines the financial and clinical aspects of healthcare and uses a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care.

Investor-owned hospital chain

publicly traded for-profit froups of hospitals

Licensure

Gives legal approval for a facility to operate or for a person to practice within his or her profession.

Long-term care

Is the healthcare rendered in a non-acute-care facility to patients who require inpatient nursing and related services for more than 30 consecutive days.

Managed care

Is a generic term for a healthcare reimbursement system that manages cost, quality, and access to services.

Managed care organization (MCO)

Healthcare organizations assume the financial risk as well as provide healthcare services for a defined population of patients

Medicaid

A medical assistance program for low-income Americans. Funded partially by the federal government and partially by state and local governments.

Medical device

A company produces devices such as instruments, machines, or an implement or apparatus intended for use in the diagnosis of disease or for monitoring or treatment of a condition.

Medical staff bylaws

The Medical staff operates according to a predetermined set of policies.

Medical staff classification

Refers to the organization of physicians according to clinical assignment.

Medicare

Was first offered to retired Americans in July 1966. Today, retired and disabled Americans who are eligible for Social Security benefits automatically qualify for this coverage without regard to income.

Mission

A written statement that sets forth the core purpose and philosophies of an organization or group; defines the organization or group’s general purpose for existing; also known as a blank statement.

Multihospital system

Includes two or more hospitals owned, leased, sponsored, or contract managed by a central organization.

Network

A group of hospitals, physicians, and other providers and payers that collaborate to coordinate and deliver services to their community.

Not-for-profit

This healthcare organization uses excess funds to improve their services and to finance educational programs and community services.

Organized healthcare delivery

Can be defined as “that care providers have established relationships and mechanisms for communicating and working to coordinate patient care across health conditions, services, and care settings over time”.

Patient-focused care

Is a concept developed to contain hospital inpatient costs and improve quality by restructuring services so that more of them take place in the nursing units (patient floors) and not in specialized units in dispersed hospital locations.

Peer review

A member of a profession assesses the work of colleagues within that same profession. Been at the center of quality assessment and assurance efforts.

Point of service (POS) plan

Let the beneficiary choose between the HMO or PPO model each time care is accessed.

Post-acute care

Supports patients who require ongoing medical management or therapeutic, rehabilitative, or skilled nursing care.

Preferred provider organization (PPO)

Usually will pay for care delivered outside the network, but it may cost the individual more.

Retail clinics

Clinics that treat non-life threatening acute illnesses and offer routine wellness services such as flu shots, sports physicals, and prescription refills

Skilled nursing facility (SNF)

AKA nursing homes provide medical, nursing, and, in some cases, rehabilitative care around the clock.

Surgeon general

Is appointed by the president of the United States and provides leadership and authoritative,science-based recommendations about the public’s health.

Telehealth

Uses communication technology between the patient and the provider or the provider and a specialist to deliver healthcare services.

TRICARE

Which was originally referred to as the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS), pays for care delivered by civilian health providers to retired members of the military and the dependents of active and retired members of the seven uniformed services.

Values

1. The social and cultural belief system of a person or a healthcare organization.

2. A descriptive list of the organization’s fundamental principles or beliefs

Value-based purchasing

Launched in 2013, the intent is to pay for care that rewards better value, patient outcomes, and innovation rather than just the volume of care provided.

Vision

A picture of the desired future that sets a direction and rationale for change.

Workers’ compensation

An insurance system operated by the individual states.