Healthcare Terminology and Concepts, Exams of Sociology

Download Healthcare Terminology and Concepts and more Exams Sociology in PDF only on Docsity! CHAA Exam 120 Questions with Verified Answers. Scatter Diagram - Correct Answer a graphic display of data plotted along two dimensions used to screen for a relationship between two variables Run Chart - Correct Answer a visual display of data that enables monitoring of a process to determine whether there is a systemic change in process over time Pareto Chart - Correct Answer A graphic representation of the frequency with which certain events occur may be used to set priorities or oppotunities for improvement Measure - Correct Answer A number assigned to an object or event Gantt Chart - Correct Answer A type of bar chart used in process or project planning and control to display planned work targets for completion of work in relation of time usually shows week month quarter Just In Time - Correct Answer A method of ordering items as close to possible to their time of need Clinical Pathway - Correct Answer management tool that organizes sequences and times the major intervention of the nursing staff physicians and other departments AKA care map; critical path Histogram - Correct Answer a graphic display used to plot the frequency with which different valves of a given variables occur. Used to examine patterns Algorithm - Correct Answer Recommended patient management strategies designed to direct decision making Baseline - Correct Answer An observation or value that represents the background of measurable quanitity Six Sigma - Correct Answer process improvement technique for blending organizational wisdom with proven statistical tools Balanced Scorecard - Correct Answer strategic management system used to drive performance and accountability through the organization Plan; Do; Check; Act; - Correct Answer AKA Deming or Shewart cycle FOCUS - Correct Answer Find a process Organize a team Clarify Knowledge Uncover the cause Start Plan Do Act Check 5 major points of collection - Correct Answer Before service; At registration; During service; At Discharge; Collection follow-up Standing Orders - Correct Answer Physician orders pre-established and approved for use by nurses under specific conditions in absence of the physician Threshold - Correct Answer a level of achievement that determines the difference between what is deemed to be acceptable Laws that Illinois House Healthcare Availability and Access Committee passed - Correct Answer 1. the tax exempt hospital responsibility act- says that hospitals must use 8% of cost to provide care for poor 2. The fair Billing and Collection Practices Act-makes hospital quit aggressive ways to collect payments Accepting Assignment - Correct Answer when a provider agrees to accept the allowable charges as full fee Acute Care - Correct Answer the care is generally short term rather than chronic care Assignment of Benefits AOB - Correct Answer Written authorization from the policyholder for the insurance company sends payment directly to providers Adverse Selection - Correct Answer the tendency for those with impaired health status or who are prone to higher than average utilization of benefits to be enrolled in disproportionate numbers and lower deductible plans Ambulatory Surgical Center - Correct Answer a freestanding facitlity other than a physician office where surgical and outpatient services take place Acute Inpatient Care - Correct Answer generally short term less than 30 days Add-ons - Correct Answer Patients who are scheduled for services less than 24 hours in advance of actual service time Admission Authorization - Correct Answer the process of third party payor notification of urgent/emergent inpatient admission with specific time frame 3 steps of verbal communication - Correct Answer 1. encoding-translating idea into words; 2. transmission-face to face or letter; 3. decoding-receiver must interpet the message Medicaid - Correct Answer provides insurance to low income people; funded by state and federal govt.; states design program qual.; low income; aged blind or disable Medigap Insurance - Correct Answer designed to help pay Medicare cost sharing amounts such as coinsurance and deductibles and uncovered services Medicare Beneficary Notice MBN - Correct Answer monthly statement that list claims information When Medicare is secondary payer - Correct Answer 65 or older is covered by group health insurance which is provided by employer with more than 20 employees; below 65 disabled and member of household is working at employer with more than 100 employees covered by workers comp. patient has ESRD Important Message from Medicare IMM - Correct Answer Lets beneficiaries know their rights provides # to PRO Lifetime Reserve Days - Correct Answer Medicare will pay for an additional 60 days of hospitalization when stay is longer than 90 days Tricare Prime - Correct Answer Like HMO Tricare Extra - Correct Answer Like PPO saves money for patients Payor Authorization - Correct Answer approval given from third party payors to provide spec. care Pre-encounter communications - Correct Answer oral or written information shared with patients prior to arrival for service Order entry - Correct Answer entering orders for clinical services into information systems Departure - Correct Answer preparation and actual departure of patient from an encounter Charge Capture - Correct Answer process of electronically or manually applying predetermined fees Peer Review Organization PRO - Correct Answer Centers for Medicaid and Medicare services; designed to improve Medicare; national network has 53; Aka QIO Relative Value Resource Based System RVRBS - Correct Answer paying doctors according to national fee schedule based on work and costs associated with each service Diagnosis Related Group DRG - Correct Answer system where CMS began paying doctors a fixed rate per patient based on diagnosis Fiscal Intermediaries FI - Correct Answer processes claims for Medicare Part A Carriers - Correct Answer processes claims for Part B (Medicare) Medicare - Correct Answer Federal health Insurance program; people 65 or older; people of any age with renal; certain disabled people under 65 Medicare Part A - Correct Answer pays for:hospital services inpatient skilled nursing services and hospice Medicare Part C - Correct Answer private insurance company offering plans mostly to seniors (PPO or HMO) Medicare Part B - Correct Answer pays for doctor services; outpatient hospital; medical equipment Medicare Part D - Correct Answer helps cover medicines Benefit Periods - Correct Answer begins on the first day of services if patient goes in a facility and ends 60 days after discharge as long as it is not interrupted by another facility; the # of days Medicare covers Respite Care - Correct Answer short term care provided at home in a long term care facility not pai for by Medicare or Medicaid Relative Value Scale - Correct Answer A list of procedure codes that uses units to indicate the relative value of medical services usually used in workers Comp. Predetermination - Correct Answer An administrative procedure whereby a health provider submits a treatment plan Recidivism - Correct Answer The frequency of the same patient being readmitted to the hospital for the same condition Palliative Care - Correct Answer active total care of patients who have advanced illnesses no longer amenable to curative treatment control of symptoms is the focus Outlier - Correct Answer one who does not fall within the norm a term typically used in utilization review. a provider who uses either too many or too few services Open Access - Correct Answer a self referral arrangement allowing members to see participating providers for specialty care without a referral form AKA open panel Non-availability Statement - Correct Answer a statement issued by a uniformed service hospital when medical care is not available at their institution and the patient must use civilan healthcare; if the patient lives outside the zip; doesn't need statement Independent Practice Association IPA - Correct Answer health maintenance organization(HMO) delivery model in which the HMO contracts with physician organization HCFA 1450 - Correct Answer Medicare Part A claim form used for inpatients and outpatient encounters AKA UB92 Explaination of Benefits EOB - Correct Answer the statement sent to covered person by health plan listing services provided benefits paid on a claim; deductible and copayment Evidence of Coverage EOC - Correct Answer an addendum of a group plan contract and constitutes only a summary of the terms and conditions of coverage Consolidated Omnibus Budget Reconciliation Act COBRA - Correct Answer requries employers to permit employees/family to continue their group insurance coverage at their own expense Comorbidity - Correct Answer a pre-exisiting condition that will because of its persence cause an increased stay in the hospital AkA substantial complication Conservator - Correct Answer a person offical or institution designated to take over and protect the interests of an incompetent person The Common Working File - Correct Answer a national file fo Medicare claims Closed Access - Correct Answer a provision which specifies that plan members must obtain medical services only from PCP to get benefits Clincal Integration - Correct Answer a type of operational integration that enables patients to receive a variety of health services from the same entity Charge Description Master CDM - Correct Answer a master file in a computer system listing the services provided at the hospital that have an assigned charge Case Mix Index CMI - Correct Answer determined by dividing the sum of all the DRG relative weights for every DRG used by Medicare patients by the total # of Medicare inpatient cases for the hospital Centers for Disease Control and Prevention - Correct Answer one of the operating compoents of the Dept. Of health and human services; they monitor health; detect and investigate health problems; conduct research