Health Information Management: Study Notes Packet

adjudication

process used by health plants to determine amt. of payment for a claim

brand name drug

prescription drug patented & only available thru one manufacturer

generic drug

a drug which is the pharmaceutical equivalent to one or more brand name drugs

diagnostic test

any kind of med. test performed to aid in the diagnosis or detection disease

inpatient

someone who stays in a hospital while under treatment

outpatient

someone who receives medical treatment w/o being admitted to a hospital

preventive care

routine phys. exams & immunizations

home health care

skilled nursing & related health services give to patients in home setting

hospice

a facility or program designed to provide a caring environment for meeting the physical & emotional needs of the terminally ill

pre-existing conditions

a health condition or illness you have b4 1st day of coverage on a new plan

UPIN (abv.)

unique physician identification number

UPIN

old 6 digit ID used by Medicare to track doctors, replaced by NPI

SCHIP (abv.)

State Children Health Insurance Program

SCHIP

gov. insurance for kids & infants that earn too much for Medicaid but cant afford private plans

SSN (abv.)

Social Security Number

SSN

9 digit federal ID used in healthcare to verify identity & match patient-records

RFI (abv)

request for information

RFI

formal ‘fact finding’ doc sent to vendors to see what software or services they offer

ROI (abv.)

release of information

ROI

legal process of sharing a patient’s medical records w/ an authorized person or office

PHI (abv.)

protected health information

PHI

any personal info that can link a specific patient to their medical data

ICD-10-PCS (abv.)

Procedure Coding System

ICD-10-PCS

specific code set used strictly for hospital inpatient procedure in the U.

HIPAA (abv.)

Health Insurance Portability & Accountability Act

HIPAA

federal law that sets rules for keeping patient data private & secure

EOB (abv.)

explanation of benefits

EOB

statement from the insurance company showing what they paid for a visit & what you owe

EMR (abv.)

electronic medical record

EMR

digital version of patient’s paper cart used w/ in a single provider’s office